MedWorm: Pain Management

Atypical facial pain related to apical fenestration and overfilling

International Endodontic Journal — Wed, 08 Feb 2012 16:25:28 +0100

Pasqualini D, Scotti N, Ambrogio P, Alovisi M, Berutti E. Atypical facial pain related to apical fenestration and overfilling. International Endodontic JournalAbstractAim To report a case of apical fenestration and overfilling in which unusual pain characteristics made differential diagnosis challenging.Summary A 32‐year‐old woman with diffuse, spontaneous, moderate pain in the maxillary left posterior sector, exacerbated by masticatory and facial muscle movement, with intense sporadic electric‐shooting pain, underwent clinical examination and 3D cone beam computed tomography (CBCT). Apical fenestration with protrusion of the mesial root of tooth 26 beyond the buccal cortical plate, extrusion of canal filling material into the soft tissues and a periosteal reaction were detecte...

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Researchers at the Stanford University School of Medicine are using EMRs to make pain research breakthroughs

ICMCC: The International Council on Medical and Care Compunetics — Wed, 08 Feb 2012 13:49:38 +0100

Source: Gabriel Perna, Healthcare Informatics Content: “In the world of medical research, the emergence of the electronic medical record (EMR) in hospitals is a game-changer, giving researchers the opportunity to use large, previously unobtainable data sets for their studies. You don’t have to tell that to Atul Butte, M.D., director for the Center for Pediatric [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

A Descriptive Feasibility Study to Evaluate Scheduled Oral Analgesic Dosing at Home for the Management of Postoperative Pain in Preschool Children Following Tonsillectomy

Pain Medicine — Tue, 07 Feb 2012 05:00:00 +0100

Discussion. Study results suggest that acetaminophen with hydrocodone is effective in relieving preschool children's pain following tonsillectomy and that parental adherence to a scheduled analgesic regimen decreases over time. Time‐contingent dosing was associated with moderate to severe side effects and should be addressed in discharge teaching with parents. Findings provide insight into parents' perspective of pain management at home following tonsillectomy and methods for relieving their child's pain. (Source: Pain Medicine)

Management of Neuropathic Pain with Methylprednisolone at the Site of Nerve Injury

Pain Medicine — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions. Our results suggest that peripheral nerve block with 80 mg depo‐methylprednisolone plus 0.5% lidocaine provides effective management in the treatment of neuropathic pain due to peripheral nerve damage. (Source: Pain Medicine)

Addressing Both Depression and Pain in Late Life: The Methodology of the ADAPT Study

Pain Medicine — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions. The results of this trial will inform the care of these complex patients and further understanding of comorbid pain and depression in late life. (Source: Pain Medicine)

Health Economics of Interdisciplinary Rehabilitation for Chronic Pain: Does it Support or Invalidate the Outcomes Research of These Programs?

Current Pain and Headache Reports — Mon, 06 Feb 2012 19:34:33 +0100

Abstract Interdisciplinary rehabilitation has been shown to be effective for treatment of patients suffering from chronic nonmalignant pain with respect to activity level, pain intensity, function, or days of sick leave. However, effects in clinical outcome do not necessarily imply a superiority of the intervention from an economic point of view. Despite an increasing number of cost-utility and cost-effectiveness studies, systematic reviews outline the methodological heterogeneity of studies, which makes it impossible to perform meta-analyses and to draw conclusions from the studies. Recent publications add interesting information to the current discussion; these studies cover the long-term development of sickness absence post-intervention and the cost effectiveness of wor...

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Sympathetic Blocks Provided Sustained Pain Relief in a Patient with Refractory Painful Diabetic Neuropathy

Comparative and Functional Genomics — Mon, 06 Feb 2012 14:15:44 +0100

The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive inv...

Social Support Is Critical for Depression Recovery

Psych Central — Sun, 05 Feb 2012 20:38:51 +0100

Every human being wants to belong. This need is so strong that people will do nearly anything to feel like they are part of something. Personal relationships form a safety net around individuals to protect them from too much isolation. Long ago, people who strayed from a group had a much harder time surviving the elements or avoiding starvation. While it’s physically safer now to live a solitary life, emotional isolation can still threaten a person’s mental well-being. Social support is a vital and effective part of depression recovery. It can turn around damaging isolation, affect a person’s life focus, and generate solutions for depression management. Learn more about how this powerful social force can positively effect someone living with depression. Social Connection Curbs You...

A Comprehensive Review of Telehealth for Pain Management: Where We Are and The Way Ahead

Pain Practice — Sun, 05 Feb 2012 05:00:00 +0100

AbstractPain is generally undertreated in the United States, owing to a number of barriers including geographic distance from specialty treatment providers; functional disability that limits mobility; treatment‐related stigma; economic limitations; and educational barriers. Pain undertreatment exacerbates pain chronicity and emotional disruption that can significantly erode a pain patient’s quality of life, and there is widespread agreement that pain care must evolve to address this significant problem. The growing field of telehealth (defined for the purposes of this paper as technology that allows for distance interaction between providers and/or patients) offers a novel opportunity to expand pain assessment, consultation, and treatment services beyond the walls of the specialty pain...

Use and Costs of Prescription Medications and Alternative Treatments in Patients with Osteoarthritis and Chronic Low Back Pain in Community‐Based Settings

Pain Practice — Sun, 05 Feb 2012 05:00:00 +0100

Conclusions: Patients with OA and CLBP used a variety of pain‐related and adjunctive medications. Although, alternative treatments are widely recommended, we found limited use of several of these in clinical practice, potentially due to the source of our data (commercial claims). Further research is needed to ascertain the extent to which such therapies contribute to the total costs of OA and CLBP management. (Source: Pain Practice)

NeurogesX Grants Equity Awards Under Its 2011 Inducement Stock Plan

Medical News (via PRIMEZONE) — Fri, 03 Feb 2012 21:15:00 +0100

SAN MATEO, Calif., Feb. 3, 2012 (GLOBE NEWSWIRE) -- NeurogesX, Inc. (Nasdaq:NGSX), a specialty pharmaceutical company focused on developing and commercializing a portfolio of novel non-opioid, pain management therapies, today announced that the Board of Directors granted equity awards under its 2011 Inducement Stock Plan (the "Plan") to its recently appointed President and Chief Executive Officer Ronald A. Martell. The Plan was originally adopted by the Board of Directors in September 2011 pursuant to NASDAQ Listing Rule 5635(c)(4) as a means of making stock grants to senior executives as an inducement to their joining the Company. (Source: Medical News (via PRIMEZONE))

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What Do I Do With My Paper Chart? — The Middle of the Road Makes the Most Sense

ICMCC: The International Council on Medical and Care Compunetics — Fri, 03 Feb 2012 09:00:43 +0100

Source: Seth Flam, Becker's Orthopedic, Spine & Pain Management Content: “Many healthcare providers who are transitioning from paper charts to electronic health records need help understanding how to work with the paper charts they built over their many years in practice. There are three general approaches.” Article Seth Flam, Becker’s Orthopedic, Spine & Pain Management, 2 February [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Series of 8 cases of Irukandji syndrome? or bait-and-switch

The Poison Review — Fri, 03 Feb 2012 07:23:04 +0100

1.5 out of 5 stars Irukandji Sydrome [sic] in the Torres Strait: A Series of 8 Cases. McIver LJ et al. Wilderness Environ Med 2011;22:338-342. Abstract The problems with this paper merely begin with the dropped “n” in the second word of the title. Then we get to the first sentence of the abstract, where despite the title’s promise of a case series of Irukandji syndrome (or sydrome, or whatever) we find a classic medical literature bait-and-switch: Objective–To review the presentations of a series of patients with suspected Irukandji syndrome in the Torres Strait, where the syndrome has hitherto been unknown or undocumented, in order to identify at-risk groups and improve the management of this condition in the region. So we’re dealing not with cases of Irukan...

Neuromodulators for pain management in rheumatoid arthritis

Prescriber — Fri, 03 Feb 2012 06:47:12 +0100

(Source: Prescriber)

Acute Genital Ulcers in Nonsexually Active Young Girls: Case Series, Review of the Literature, and Evaluation and Management Recommendations

Pediatric Dermatology — Fri, 03 Feb 2012 05:00:00 +0100

Abstract: Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplina...

Low-Risk Chest Pain In The Emergency Department: Current Guidelines

EM Practice Guidelines Update — Thu, 02 Feb 2012 19:20:39 +0100

This issue of EM Practice Guidelines Update reviews 3 scientific statements that focus on strategies for the management of chest pain patients with possible acute coronary syndromes (ACS). (Source: EM Practice Guidelines Update)

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Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction

Intensive Care Medicine — Thu, 02 Feb 2012 18:13:11 +0100

Conclusion Copeptin in association with HsTnT is a fast and reliable tool to rule out AMI, with a sensitivity and NPV of 1.00 in our sample. Interventional studies are warranted to confirm these findings. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-012-2481-8Authors Yonathan Freund, Service d’Accueil des Urgences, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris (APHP), Université Pierre et Marie Curie-Paris 6 (UPMC), 47-83 Boulevard de l’Hôpital, 75651 Paris cedex 13, FranceCamille Chenevier-Gobeaux, Departement de Biochimie, Hôpital Cochin–Hôtel Dieu, APHP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, FranceYann-Erick Claessens, Service d’Accueil des Urgences, Hôpital Cochin–Hôtel Dieu, AP...

Helping Seniors With Pain: New GSA Resources

Health News from Medical News Today — Thu, 02 Feb 2012 09:00:00 +0100

The pain suffered by older adults is the shared focus of the two newest entries in The Gerontological Society of America's (GSA) From Publication to Practice* series. Together they address both pain management and new labeling changes for one of the most popular pain medications, acetaminophen. Both issues aim to provide readers with information on how new advances in pain prevention, treatment, and management may improve care and quality of life for older adults... (Source: Health News from Medical News Today)

Rational opioid dosing in the elderly: dose and dosing interval when initiating opioid therapy

NeLM - Care of Older People — Thu, 02 Feb 2012 05:00:00 +0100

Source: Clinical Pharmacology and Therapeutics Area: Evidence > Medicines Management > References Opioids are the mainstay of treatment for moderate to severe pain. However, opioid therapy in the elderly is often associated with significant morbidity because of excessive ventilatory depression. The large amount of interindividual variability in opioid dose-response relationships makes it difficult to individualise the dose and dosing interval to provide safe and effective analgesia. By examining how aging affects the pharmacokinetics (PK) and pharmacodynamics (PD) of opioids, it is possible to provide a rational basis for age adjustment in opioid dosing. Authors conclude that 'simulations with PK-PD models confirm the clinical impression that elderly patients n...

Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour

NeLM - Drug Specific Reviews — Thu, 02 Feb 2012 05:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Specific Reviews Background Intracutaneous or subcutaneous injection of sterile water is rapidly gaining popularity as a method of pain relief in labour and it is therefore essential that it is properly evaluated. Adequate analgesia in labour is important to women worldwide. Sterile water injection is inexpensive, requires basic equipment, and appears to have few side effects. It is purported to work for labour pain. Objectives To determine the efficacy of sterile water injections for relief of pain (both typical contraction pain and intractable back pain) during labour compared to placebo (isotonic saline injections) or non-pharmacological interventions, and to identify any relevant effects on mode and timing of delivery, or ...

Pelvic Inflammatory Disease: Current Concepts of Diagnosis and Management

Current Infectious Disease Reports — Wed, 01 Feb 2012 17:11:35 +0100

Abstract Pelvic inflammatory disease (PID), one of the most common infections in non-pregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon clinicians having a high index of suspicion in order to make an early diagnosis and development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are pr...

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A collaborative expert literature review of pain education, assessment and management

Future Medicine: Aging Health — Wed, 01 Feb 2012 14:53:35 +0100

Aging Health , February 2012, Vol. 8, No. 1, Pages 43-54. (Source: Future Medicine: Aging Health)

Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial

BMC Health Services Research — Wed, 01 Feb 2012 05:00:00 +0100

DiscussionThe discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study. There is strong evidence that long periods of sick leave can result in work disability, poorer general health and increased risk of mental health problems. We expect that this multidisciplinary care program will improve peri-operative care, contribute to a faster return to work of patients after gynaecological surgery and, as a consequence, will reduce societal costs considerably.Trial registration: Netherlands Trial Register NTR2087 (Source: BMC Health Services Research)

Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis)

NeLM - Disease Focused Reviews — Wed, 01 Feb 2012 05:00:00 +0100

Source: Cochrane Area: Evidence > Disease Focused Reviews Background Even with optimal disease-modifying treatment and good control of disease activity, persistent pain due to structural damage is common in people with inflammatory arthritis and therefore additional treatment for pain might be required. Because comorbidity is highly prevalent in people with inflammatory arthritis, it is important to consider comorbidities such as gastrointestinal or liver diseases in deciding upon optimal pharmacologic pain therapy. Objectives To assess the efficacy and safety of pharmacological pain treatment in patients with inflammatory arthritis who have gastrointestinal or liver comorbidities, or both. Search methods We searched MEDLINE, EMBASE...

The Economic Cost of Chronic Noncancer Pain in Ireland: Results From the PRIME Study, Part 2

The Journal of Pain — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: To assess the economic cost of chronic pain in Ireland, information was gathered from 140 people with chronic pain. Direct and indirect costs attributable to chronic pain and medical conditions of which chronic pain was a feature were recorded retrospectively for 12 months. Mean cost per chronic pain patient was estimated at €5,665 per year across all grades of pain, with mean costs increasing according to the severity of pain. A small proportion of patients account for the bulk of costs—the top 5% most expensive patients accounted for 26.4% of costs, with a mean cost per patient of €29,936, and the 10% most expensive patients were responsible for 42.8% of all costs. Total cost for individuals aged 20 and above was estimated at €5.34 billion per year, or 2.86% of Irish GD...

Chronic Female Pelvic Pain—Part 2: Differential Diagnosis and Management

Pain Practice — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Pelvic pain is a common condition. Treatment interventions have traditionally targeted biomedical conditions with variable success. Utilizing a systematic approach to examination of the pelvic girdle and related organ systems contained within the pelvis will aid the clinician in identifying the painful structure(s) as well as the associated impairments limiting functional recovery. From this, a complete management program can be instituted. The following description of gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic conditions that can cause or are associated with chronic pelvic pain leads to conservative management proposals based on the available evidence. Finally, nonoperative interventional strategies are described, which target the pain system fro...

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Functions and Outcomes of a Clinical Medical Ethics Committee: A Review of 100 Consults.

Pain Physician — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. PMID: 22302457 [PubMed - as supplied by publisher] (Source: Pain Physician)

Postoperative Headache Following Acoustic Neuroma Resection: Occipital Nerve Injuries Are Associated With a Treatable Occipital Neuralgia.

Headache — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion.- In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries. PMID: 22296035 [PubMed - as supplied...

Interventional radiology in oncology: clinical management of patients undergoing transarterial chemoembolization for hepatic malignancies.

Clinical Journal of Oncology Nursing — Wed, 01 Feb 2012 05:00:00 +0100

Authors: Perez-Rojas E Abstract Interventional radiology procedures treat a variety of solid tumor malignancies. Transarterial chemoembolization (TACE) is a minimally invasive procedure performed under fluoroscopic guidance that is used in treatment of hepatic malignancies because of hepatocellular carcinoma or malignancy that has metastasized to the liver. Patients undergoing a TACE procedure may manifest postembolization symptoms such as fever, nausea, vomiting, and abdominal pain, which may persist after discharge. Patients need to be educated on the importance of compliance with prescribed medications, clinical symptoms to be expected, and signs of potential complications that need to be reported. PMID: 22297011 [PubMed - in process] (Source: Clinical Journal of Oncology Nu...

Anaesthesia and minimally invasive surgery

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

This article will focus on the pathophysiological changes caused by CO2 pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications. (Source: Anaesthesia and intensive care medicine)

Cardiac CT in the Emergency Department

Cardiology Clinics — Wed, 01 Feb 2012 05:00:00 +0100

Current triage strategies are not effective in correctly identifying patients suffering from acute coronary syndrome (ACS). The diagnostic workup of patients presenting with acute chest pain continues to represent a major challenge for emergency department (ED) personnel. This statement holds especially true for patients with a low to intermediate likelihood for ACS. Taking current concepts for the diagnosis and management of patients presenting with acute chest pain to the ED into account, this article discusses the evidence and potential role of coronary computed tomography angiography to improve management of patients with possible ACS. (Source: Cardiology Clinics)

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Natural language processing in EMRs can improve disease tracking

ICMCC: The International Council on Medical and Care Compunetics — Tue, 31 Jan 2012 11:09:31 +0100

Source: Jaan Sidorov, KevinMD Content: “Years ago, if you were elderly, had diabetes, high blood pressure, low back pain, needed a yearly flu shot and came to see this electronic health record-enabled physician (now with the nom de plume “Disease Management Care Blog”), you would have had your diabetes, high blood pressure and low back [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

The Effect of Imaging on the Clinical Management of Breast Pain

Journal of General Internal Medicine — Tue, 31 Jan 2012 07:11:11 +0100

CONCLUSIONS Initial imaging for women with breast pain increased the odds of subsequent clinical utilization and did not increase reassurance in ruling out malignancy. Content Type Journal ArticleCategory Original ResearchPages 1-8DOI 10.1007/s11606-011-1982-4Authors Mary Beth Howard, Women’s Health Unit, Section of General Internal Medicine, Department of Medicine, and Women’s Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USATracy Battaglia, Women’s Health Unit, Section of General Internal Medicine, Department of Medicine, and Women’s Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA...

Laparoscopic management of complicated urachal remnants in adults

World Journal of Urology — Tue, 31 Jan 2012 07:06:01 +0100

Conclusion A laparoscopic approach with the removal of urachal remnants via the umbilicus appears to be a safe and effective alternative with better cosmesis when compared to an open approach. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00345-012-0829-xAuthors Motoo Araki, Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 JapanTakashi Saika, Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 JapanDaiji Araki, Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikat...

New GSA resources lay foundation for relieving seniors' pain

EurekAlert! - Social and Behavioral Science — Tue, 31 Jan 2012 05:00:00 +0100

(The Gerontological Society of America) The pain suffered by older adults is the shared focus of the two newest entries in the Gerontological Society of America's "From Publication to Practice" series. Together they address both pain management and new labeling changes for one of the most popular pain medications, acetaminophen. Both issues aim to provide readers with information on how new advances in pain prevention, treatment, and management may improve care and quality of life for older adults. (Source: EurekAlert! - Social and Behavioral Science)

Neuromodulators for pain management in rheumatoid arthritis

NeLM - Drug Class Focused Reviews — Tue, 31 Jan 2012 05:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Class Focused Reviews Background Pain management is a high priority for patients with rheumatoid arthritis (RA). Despite deficiencies in research data, neuromodulators have gained widespread clinical acceptance as adjuvants in the management of patients with chronic musculoskeletal pain. Objectives The aim of this review was to determine the efficacy and safety of neuromodulators in pain management in patients with RA. Neuromodulators included in this review were anticonvulsants (gabapentin, pregabalin, phenytoin, sodium valproate, lamotrigine, carbamazepine, levetiracetam, oxcarbazepine, tiagabine and topiramate), ketamine, bupropion, methylphenidate, nefopam, capsaicin and the cannabinoids. Search ...

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Muscle relaxants for pain management in rheumatoid arthritis

NeLM - Drug Class Focused Reviews — Tue, 31 Jan 2012 05:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Class Focused Reviews Background Pain management is a high priority for patients with rheumatoid arthritis (RA). Muscle relaxants include drugs that reduce muscle spasm (for example benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan) and non-benzodiazepines such as metaxalone (Skelaxin) or a combination of paracetamol and orphenadrine (Muscol)) and drugs that prevent increased muscle tone (baclofen and dantrolene). Despite a paucity of evidence supporting their use, antispasmodic and antispasticity muscle relaxants have gained widespread clinical acceptance as adjuvants in the management of patients with chronic musculoskeletal pain. Objectives The aim of this review was to determin...

Common Sonographic Findings in the Painful Hip After Hip Arthroplasty

Journal of Ultrasound in Medicine — Tue, 31 Jan 2012 05:00:00 +0100

Diagnosing the cause of hip pain in patients with hip arthroplasty can be challenging because of the numerous possible causes of pain and artifacts caused by the prosthetic components on computed tomography and magnetic resonance imaging. Sonography plays an important role in the diagnosis and management of these patients because the soft tissues surrounding the prosthetic joint are not obscured by artifacts and because sonography enables hands-on examination of the painful site, dynamic evaluation of moving structures, and comparison with the opposite side. Another advantage of sonography is the ability to perform sonographically guided diagnostic and therapeutic procedures. In this pictorial essay, we highlight commonly encountered sonographic findings in patients with hip pain after hip...

The "AMID" Hernia and Skin Stapler for Lichtenstein Hernia Repair: A Pilot Study.

Surgical Innovation — Tue, 31 Jan 2012 05:00:00 +0100

Conclusion. The Lichtenstein hernia repair using the AMID Stapler is simple and safe and resulted in lower acute postoperative pain and lower analgesic consumption as compared with the sutured Lichtenstein hernia repair. A multicenter clinical trial with a large sample size is needed to more accurately study pain reduction. PMID: 22298754 [PubMed - as supplied by publisher] (Source: Surgical Innovation)

Cognitive decline in patients with metal-on-metal hips: think cobalt toxicity

The Poison Review — Tue, 31 Jan 2012 04:56:05 +0100

This weekend both the Daily Mail (U.K.) and the Sunday Telegraph (U.K.) had stories highlighting the dangers of metal-on-metal artificial hips, which have a high rate of failure, causing local tissue inflammation, pain, and leaching of chromium and cobalt into blood and other tissues. A recent letter to the BMJ (Arthroprosthetic cobaltism associated with metal on metal implants. BMJ 2012;344:e430) describes several patients who received the metal-on-metal hip implants who developed progressive hip pain, elevated cobalt levels, cognitive impairment, neuropathy, and cardiomyopathy. Associated symptoms included new onset depression, anxiety, tinnitus, and thyroid abnormalities. Dr. Stephen S. Tower, the author of the BMJ letter, suggests that patients with these implants should be suspe...

Go Slow With Drug Tx for Addicted Newborns (CME/CE)

MedPage Today Pain Management — Mon, 30 Jan 2012 23:53:24 +0100

(MedPage Today) -- Withdrawal syndrome in neonates can be treated with drugs if it's severe, but only with caution, the American Academy of Pediatrics recommended. (Source: MedPage Today Pain Management)

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Incidence of unanticipated difficult airway in obstetric patients in a teaching institution

Journal of Anesthesia — Mon, 30 Jan 2012 16:07:54 +0100

Conclusion Unanticipated difficult airways accounted for 0.56% of all pregnancy-related surgical patients. More than 99.9% of all obstetric patients could be intubated. A difficult airway is more likely to be encountered by anesthesia providers with <1 year of experience. Proper use of airway equipment may help secure the obstetric airway or provide adequate ventilation. Emergency CD did not add an additional level of difficulty over nonemergency CD. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00540-012-1338-1Authors Weike Tao, Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USAJason T. Edwards, Department of Anesthes...

Epidural Plus Fever During Labor Put Baby at Risk (CME/CE)

MedPage Today Pain Management — Mon, 30 Jan 2012 16:00:00 +0100

(MedPage Today) -- A temperature spike during labor with epidural analgesia may indicate serious risks for the baby in an otherwise low-risk delivery, researchers found. (Source: MedPage Today Pain Management)

PIP silicone gel breast implants - update

The Kings Fund - Health Management Specialist Collection — Mon, 30 Jan 2012 15:41:49 +0100

The Chief Medical Officer, Dame Sally Davies, has written to health professionals, with some more detailed guidance. The latest advice from the NHS and plastic surgery experts is that women with PiP breast implants do not need to have them removed unless they have symptoms such as pain and tenderness. Letter Patient information Department of Health - publications (Source: The Kings Fund - Health Management Specialist Collection)

Fears of faulty 'toxic' hip replacement implant

NHS News Feed — Mon, 30 Jan 2012 10:16:00 +0100

Many newspapers and TV stations have reported that medical regulators have launched an investigation into a type of hip replacement called a metal-on-metal (MoM) device (DePuy ASR hip replacement implant). The concern is that as the hip replacements wear down, metal particles can be released from the artificial hip, react with the soft tissue (such as muscle and ligaments) surrounding the joint and enter the bloodstream. In 2010, the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a product recall for DePuy ASR, a brand of MoM artificial hip. This meant that surgeons were told not to implant DePuy ASR hip replacements and return any unused implants to the manufacturer. The MHRA has urged surgeons to tell all patients that had received these DePuy ASR hip...

Endoscopic management of a lower clival chondroid chordoma: case report.

Turkish Neurosurgery — Mon, 30 Jan 2012 05:00:02 +0100

We report herein a case of lower clival chondroid chordoma, focusing on the surgical procedure of endoscopic endonasal surgery. A 36-yearold woman presented with progressive headache, right shoulder pain, and right hypoglossal nerve palsy. Computed tomography (CT) and magnetic resonance (MR) imaging revealed an extradural tumor located in the lower clivus, including the anterior aspect of the foramen magnum, deeply compressing the medulla and upper cervical spinal cord. Endoscopic endonasal surgery was performed via two nostrils. Since the basiocciput was destroyed by the tumor, removal of the tumor allowed identification of the middle clivus superiorly, the anterior arch of the atlas inferiorly, and anteromedial parts of occipital condyles bilaterally without drilling ...

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Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?

Arthritis Research and Therapy — Mon, 30 Jan 2012 05:00:00 +0100

Glucosamine in its acetylated form is a natural constituent of some glycosaminoglycans (e.g. hyaluronic acid and keratan sulfate) in the proteoglycans found in articular cartilage, intervertebral disc and synovial fluid. Glucosamine can be extracted and stabilized by chemical modification and used as a drug or a nutraceutical. It has been approved for the treatment of osteoarthritis (OA) in Europe to promote cartilage and joint health and is sold over the counter as a dietary supplement in the United States. Various formulations of glucosamine have been tested including glucosamine sulfate and glucosamine hydrochloride. In vitro and in vivo studies have uncovered glucosamine's mechanisms of action on articular tissues (cartilage, synovial membrane and subchondral bone) and justified its ef...

Cancer patients' pain can be helped by psychosocial interventions, say researchers

EurekAlert! - Medicine and Health — Mon, 30 Jan 2012 05:00:00 +0100

(H. Lee Moffitt Cancer Center & Research Institute) Researchers at Moffitt Cancer Center, who teamed with colleagues at five universities around the United States, analyzed past studies of cancer-related pain reduction and found that psychosocial interventions can have a beneficial effect on cancer patients' pain severity. They also found that certain psychosocial interventions provide better pain management and are effective in reducing the degree to which pain related to cancer and its treatment interferes with patients' lives. (Source: EurekAlert! - Medicine and Health)

Nonpharmacological Approaches to the Management of Chronic Pain in Community‐Dwelling Older Adults: A Review of Empirical Evidence

Journal of the American Geriatrics Society — Mon, 30 Jan 2012 05:00:00 +0100

The objective of this literature review is to gain insight into the efficacy of nonpharmacological interventions in chronic pain management in community‐dwelling older adults. An extensive search of pertinent databases was performed to identify reports of studies of nonpharmacological (physical and psychosocial) pain interventions. The review identifies intervention studies that used randomized controlled trials (RCTs) and summarizes existing evidence of effectiveness of nonpharmacological interventions. A literature search yielded 28 RCT intervention studies (18 for physical interventions and 10 for psychosocial interventions) that met inclusion criteria and are included in this review. Twenty‐one studies (75%) identified in this review demonstrated statistically significant differenc...

An exploration of nursing home managers' knowledge of and attitudes towards the management of pain in residents with dementia

International Journal of Geriatric Psychiatry — Mon, 30 Jan 2012 05:00:00 +0100

ConclusionsThe study has revealed that accurate pain assessment, training of nursing staff and a standardised approach to pain management (the use of pain management guidelines) within nursing homes all have a significant part to play in the successful management of pain in residents with dementia. Copyright © 2012 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)

Systematic review of the emotional state and self‐management of widows

Nursing and Health Sciences — Mon, 30 Jan 2012 05:00:00 +0100

This study reviewed evidence about the emotional state of widows. Both qualitative and quantitative studies were included in the review. A systematic search was made of the OVID Medline, PubMed, ProQuest, and EBSCOhost/Academic Search Premier databases using the following search words: “depression”, “elderly”/“older”, “emotional state”, “mood”, “self‐management”, “widows”, and “women” for the period January 2000 to December 2010. Thirteen articles met the inclusion criteria, and a qualitative content analysis was used to review them. The findings revealed one main theme: “A struggle to perceive meaning in the meaningless”, which was based on three themes: “Numbing the pain and struggling to control feelings”, “Feeling sad, yet trying to maintain ...

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Perioperative Pharmacology: Patient-Controlled Analgesia

AORN Journal — Mon, 30 Jan 2012 03:56:37 +0100

Abstract: Patient-controlled analgesia (PCA) is an effective treatment option for reducing pain, but PCA errors can be quite serious. Opioid analgesics are among the most effective pain relievers available, but all have contraindications and can have adverse effects, including respiratory depression and other effects on the central nervous system. Practitioners must weigh the potential benefits of PCA use against the risks. Errors associated with the PCA process have been documented in each phase of the medication-use process; therefore, practice improvements in prescribing, transcribing, dispensing, administering, and monitoring PCA may reduce the likelihood of errors. Perioperative nurses can make important contributions to safe PCA use by establishing standardized processes to help ens...

What is the Mnemonic for the Elbow Ossification Centers?

PediatricEducation.org — Mon, 30 Jan 2012 00:11:02 +0100

Discussion Injuries to the pediatric elbow are difficult to diagnose because of the anatomy and normal growth and ossification of the elbow. Swelling, tenderness, ecchymosis, with or without deformity are common signs of fracture. Physical examination should include a careful neurovascular examination for distal pulses and capillary refill, paresthesias, increased pain with movement distal to the elbow or paralysis of the hand muscles as any of these may indicate compartment syndrome. Common radiographs obtained are AP and lateral plain radiographs. Oblique films and comparison films of the contralateral elbow are also often needed to distinguish between a fracture and normal growth plate. The alignment of the anterior humerus line and the fat pads should be reviewed as misalignment may ...

Breast Implant Infections

Infectious Diseases Clinics of North America — Sun, 29 Jan 2012 22:43:12 +0100

Infection after breast implant surgery occurs in 1.1% to 2.5% of procedures performed for augmentation and up to 35% of procedures performed for reconstruction after mastectomy. Most infections result from skin organisms and occur in the immediate postoperative period, although infections can occasionally present after many years. Diagnosis of breast implant infection relies on the clinical presentation of breast pain, swelling, erythema, and drainage in conjunction with ultrasound-guided cultures of periprosthetic fluid. Management commonly involves implant removal, with device salvage attempted in select situations. (Source: Infectious Diseases Clinics of North America)

10 Best Practices for Implementing Telemedicine in Hospitals

ICMCC: The International Council on Medical and Care Compunetics — Sat, 28 Jan 2012 11:09:46 +0100

Source: Sabrina Rodak, Becker's Orthopedic, Spine & Pain Management Content: “Telemedicine and telehealth have the potential to increase access to care, improve quality of care and decrease costs. For instance, the American Telemedicine Association proposed legislation that would expand telemedicine and save an estimated $186 million over the next 10 years. In addition, the U.S. [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Pain in blood cancers

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Pasquale Niscola, Andrea Tendas, Laura Scaramucci, Marco Giovannini, Vitaliana De SanctisIndian Journal of Palliative Care 2011 17(3):175-183Patients with blood-related cancers (BRC) suffer from a substantial symptom burden, including several pain syndromes sustained by different causes and pathogenetic mechanisms. So, with regard to pain, a multifaceted clinical scenario may be observed in this setting. Indeed, pain may be correlated to disease itself, to disease-associated complications, to iatrogenic causes or may be due to unrelated clinical conditions. A close diagnostic procedure for the assessment of the underlying causes of the pain and of its pathogenetic mechanisms may direct the treatment approach which should be based on a multidisciplinary management and requires the integrati...

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A randomized controlled trial to compare the efficacy of bisphosphonates in the management of painful bone metastasis

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Conclusion: The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm. (Source: Indian Journal of Palliative Care)

Opioid-prescribing practices in chronic cancer pain in a tertiary care pain clinic

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Conclusion: This study shows that the under treatment of pain and under dosing of opioids coupled with improper side effect management are major issues. (Source: Indian Journal of Palliative Care)

Attitudes and beliefs about chronic pain among nurses- biomedical or behavioral? A cross-sectional survey

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Conclusions: Nurses had a greater orientation toward the biomedical dimension of chronic pain than the behavioral dimension. This difference was more pronounced in female nurses and those nurses who reported "very good" general health had higher behavioral dimension scores than those who had "good" general health. The study findings have important curricular implications for nurses and practical implications in palliative care. (Source: Indian Journal of Palliative Care)

Neuropathic pain due to fibromatosis: Does anticancer treatment help?

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

We report a patient with desmoid fibromatosis of the chest wall causing brachial plexus infiltration. As the tumor was locally invasive and unresectable, he was treated with radiation therapy and oral tamoxifen. On follow-up, there was significant pain relief, sustained reduction in the tumor size, and reduced analgesic requirement. Antineoplastic treatments like local radiation therapy and targeted systemic therapy with hormones or other agents can be considered in the management of selected unresectable desmoid fibromatosis to improve symptom control and reduce polypharmacy. (Source: Indian Journal of Palliative Care)

Providing Palliative Care for a dying teen at home: Perspectives and challenges

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Malathi Nayak, Naveen SalinsIndian Journal of Palliative Care 2011 17(3):248-250Adolescents and young adults with cancer are a heterogeneous group. Management of this special group requires a broad-based interdisciplinary clinical team, which should include palliative care (PC), psychology, social work, oncology, and nursing representatives. The function of PC is to provide impeccable pain and other symptom control and to coordinate care as the disease progresses. The cure rate of cancer in adolescents is high but between 10% and 40% of them will develop incurable disease depending on tumor type and prognostic factors. PC in adolescents should also take care of the specific physical and psychosocial developmental changes in this age group. A 16-year old boy suffered with incu...

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Viscosupplementation with hyaluronic acid in the treatment for cartilage lesions: a review of current evidence and future directions

European Journal of Orthopaedic Surgery and Traumatology — Fri, 27 Jan 2012 17:56:38 +0100

Abstract Diseases involving the articular cartilage are one of the leading causes of physical impairment among the adult population. While surgical technique and advancement have allowed us effective means at treating these diseases, this is not without significant risk and morbidity. With a very solid safety profile, viscosupplementation with hyaluronic acid (HA) derivatives has become an excellent modality for treating diseased articular cartilage. Recent literature supports the use of HA not only in the management of the pain associated with osteoarthritis but also as a disease-modifying agent as well. Further studies have started to define exciting new roles for viscosupplementation in the treatment for acute injuries to the joint microenvironment. Content Type Jou...

Evaluation of postoperative pain experience in intensive care unit patients

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: The nursing team was apparently more concerned with the presence of pain than with its quality, severity or possible painful stimuli. Pain scales were not used, which suggests the need for continued education of the nursing professionals on the manner of approaching their patients and assessing their patients' pain. (Source: Revista Brasileira de Terapia Intensiva)

Q&A: Imaging Center Partners with Mobile Anesthesia Unit

Diagnostic Imaging — Fri, 27 Jan 2012 12:00:00 +0100

Diagnostic Imaging recently spoke with Dr. Rahul Desia, director of interventional pain management at EPIC Imaging, about their experiences with a mobile anesthesia unit. (Source: Diagnostic Imaging)

Long‐term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial

Arthritis Care and Research — Fri, 27 Jan 2012 10:29:25 +0100

ConclusionClinical and cost benefits of ESCAPE‐knee pain were still evident 30 months after completing the program. ESCAPE‐knee pain is a more effective and efficient model of care that could substantially improve the health, well‐being, and independence of many people, while reducing health care costs. (Source: Arthritis Care and Research)

Pain as an important predictor of psychosocial health in patients with rheumatoid arthritis

Arthritis Care and Research — Fri, 27 Jan 2012 10:29:17 +0100

ConclusionThis large cohort study demonstrates that pain is the most important predictor of a patient's psychosocial health in RA patients. This suggests that physicians should place greater emphasis on pain management. (Source: Arthritis Care and Research)

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A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health professionals.

Arthritis Research and Therapy — Fri, 27 Jan 2012 05:00:00 +0100

IntroductionOur aim was to determine whether a disease specific self-management program for primary care people with osteoarthritis (OA) of the knee (the OAK program), implemented by health professionals, would achieve and maintain clinically meaningful improvements in health related outcomes compared with a control group. Methods: Medical practitioners referred 146 primary care participants with OA of the knee. Volunteers with coexistent inflammatory joint disease or serious co-morbidities were excluded. Randomisation was to either control or OAK groups. The OAK group completed a 6 week self-management program. The control group had a 6 month waiting period before receiving the OAK program. Assessments occurred at baseline, 8 weeks and 6 months. Primary outcomes were Western Ontario and M...

Clinical Presentation and Management of Histoplasmosis in Older Adults

Journal of the American Geriatrics Society — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionAlthough most studied characteristics of histoplasmosis were similar, notable age‐related differences were present. Chronic cavitary disease and asymptomatic histoplasmosis were more common with older age. In acute histoplasmosis, the lack of chest pain and hilar lymphadenopathy may hinder diagnosis in older adults. (Source: Journal of the American Geriatrics Society)

Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists

Pediatric Anesthesia — Thu, 26 Jan 2012 12:11:28 +0100

Conclusions: Anesthesiologists in the Netherlands take a different approach when caring for intellectually disabled children and they were not aware of pain observation scales for these children. However, the majority think that intellectually disabled children are not more sensitive to pain or require more analgesia. These opinions did not change over the 4‐year period. One way to proceed is to implement validated pain assessment tools and to invest in education. (Source: Pediatric Anesthesia)

A Double‐blind, Randomized, Prospective Study of Epidural Steroid Injection vs. The mild® Procedure in Patients with Symptomatic Lumbar Spinal Stenosis

Pain Practice — Thu, 26 Jan 2012 12:10:25 +0100

Conclusions: This study demonstrated that in LSS patients suffering with neurogenic claudication, mild provides statistically significantly better pain reduction and improved functional mobility vs. treatment with ESI. (Source: Pain Practice)

Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: The outcomes reported severely limit conclusions for clinical practice. We found little robust evidence that sterile water is effective for low back or any other labour pain. Neither did we find any difference in delivery or other maternal or fetal outcomes. Further large, methodologically rigorous studies are required to determine the efficacy of sterile water to relieve pain in labour. PMID: 22258999 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis) and gastrointestinal or liver comorbidity.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: On the basis of the current review, there is scant evidence to guide clinicians about how gastrointestinal or liver comorbidities should influence the choice of pain treatment in patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or other spondylarthritis. Based upon additional studies that included a mixed population of participants with a range of rheumatic conditions, NSAIDs should be used cautiously in patients with inflammatory arthritis and a history of gastrointestinaI comorbidity as there is consistent evidence that they may be at increased risk. PMID: 22258995 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Muscle relaxants for pain management in rheumatoid arthritis.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: Based upon the currently available evidence in patients with RA, benzodiazepines (diazepam and triazolam) do not appear to be beneficial in improving pain over 24 hours or one week. The non-benzodiazepine agent zopiclone also did not significantly reduce pain over two weeks. However, even short term muscle relaxant use (24 hours to 2 weeks) is associated with significant adverse events, predominantly drowsiness and dizziness. PMID: 22258993 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Neuromodulators for pain management in rheumatoid arthritis.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: There is currently weak evidence that oral nefopam, topical capsaicin and oromucosal cannabis are all superior to placebo in reducing pain in patients with RA. However, each agent is associated with a significant side effect profile. The confidence in our estimates is not strong given the difficulties with blinding, the small numbers of participants evaluated and the lack of adverse event data. In some patients, however, even a small degree of pain relief may be considered worthwhile. Until further research is available, given the relatively mild nature of the adverse events, capsaicin could be considered as an add-on therapy for patients with persistent local pain and inadequate response or intolerance to other treatments. Oral nefopam and oromucosal cannabis have more signif...

Endoscopic or surgical intervention for painful obstructive chronic pancreatitis.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: For patients with obstructive chronic pancreatitis and dilated pancreatic duct, this review showed that surgery is superior to endoscopy in terms of pain control. Morbidity and mortality seemed not to differ between the two intervention modalities, but the small trials identified do not provide sufficient power to detect the small differences expected in this outcome.Regarding the comparison of surgical intervention versus conservative treatment, this review has shown that surgical intervention in an early stage of chronic pancreatitis seems to be a promising approach in terms of pain control and pancreatic function. Confirmation of these results is needed in other trials due to the methodological limitations and limited number of patients of the present evidence. PMID: 22...

Pentoxifylline for endometriosis.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: This review has been updated in 2011. The results of the original review published in 2009 remain unchanged. There is still not enough evidence to support the use of pentoxifylline in the management of premenopausal women with endometriosis in terms of subfertility and relief of pain outcomes. PMID: 22258970 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway II—a 24-month follow-up pilot study

Clinical Rheumatology — Thu, 26 Jan 2012 06:44:10 +0100

Abstract Treatments offered at the Maharishi Ayurveda Health Centre in Norway are based on Maharishi Vedic Medicine (MVM). MVM is a consciousness-based revival by Maharishi Mahesh Yogi, the founder of the Transcendental Meditation (TM) program of the ancient Ayurvedic medicine tradition in India. To extend from 6 to 24 months, a pilot study of the effects of the treatment program at the Health Centre on fibromyalgia. Retesting 2 years after a clinical trial. In this intention to treat study, 31 women with a diagnosis of fibromyalgia received an individually tailored program of (1) physiological purification therapy (Maharishi Panchakarma) and (2) Ayurvedic recommendations regarding daily routine and diet including a novel approach to food intolerance. Five subjec...

Radiofrequency Neurolysis in the Management of Inguinal Neuralgia: Preliminary Study [Vascular and Interventional Radiology]

Radiology — Thu, 26 Jan 2012 05:00:00 +0100

Conclusion: RFN with CT guidance is an effective technique in the management of refractory inguinal pain with lasting satisfactory pain reduction; it may be considered as an alternative treatment to surgery. These results should be confirmed in a controlled trial with a larger series of patients. © RSNA, 2011 (Source: Radiology)

Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?

Arthritis Research and Therapy — Thu, 26 Jan 2012 05:00:00 +0100

Management of Dancers With Symptomatic Accessory Navicular: 2 Case Reports.

Physical Therapy — Wed, 25 Jan 2012 05:00:00 +0100

Authors: Smith TR Abstract Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Ca...

Here Today, Gone Tomorrow…and Back Again? A Review of Herbal Marijuana Alternatives (K2, Spice), Synthetic Cathinones (Bath Salts), Kratom, Salvia divinorum, Methoxetamine, and Piperazines.

Journal of Medical Toxicology — Wed, 25 Jan 2012 05:00:00 +0100

Authors: Rosenbaum CD, Carreiro SP, Babu KM Abstract Despite their widespread Internet availability and use, many of the new drugs of abuse remain unfamiliar to health care providers. The herbal marijuana alternatives, like K2 or Spice, are a group of herbal blends that contain a mixture of plant matter in addition to chemical grade synthetic cannabinoids. The synthetic cathinones, commonly called "bath salts," have resulted in nationwide emergency department visits for severe agitation, sympathomimetic toxicity, and death. Kratom, a plant product derived from Mitragyna speciosa Korth, has opioid-like effects, and has been used for the treatment of chronic pain and amelioration of opioid-withdrawal symptoms. Salvia divinorum is a hallucinogen with unique pharmacology that has thera...

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Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management

Anesthesiology — Tue, 24 Jan 2012 22:04:33 +0100

The American Society of Anesthesiologists Committee on Standards and Practice Parameters presents an updated report of the Practice Guidelines for Acute Pain Management in the Perioperative Setting. (Source: Anesthesiology)

Postoperative intravenous morphine titration.

Pain Physician — Tue, 24 Jan 2012 19:49:41 +0100

Authors: Aubrun F, Mazoit JX, Riou B Abstract Relief of acute pain during the immediate postoperative period is an important task for anaesthetists. Morphine is widely used to control moderate-to-severe postoperative pain and the use of small i.v. boluses of morphine in the post-anaesthesia care unit allows a rapid titration of the dose needed for adequate pain relief. The essential principle of a titration regimen must be to adapt the morphine dose to the pain level. Although morphine would not appear to be the most appropriate choice for achieving rapid pain relief, this is the sole opioid assessed in many studies of immediate postoperative pain management using titration. More than 90% of the patients have pain relief using a protocol of morphine titration and the mean dose requ...

Role of Medical Therapy in the Management of Nasal Polyps

Current Allergy and Asthma Reports — Tue, 24 Jan 2012 18:14:41 +0100

Abstract Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses regarding its cause, remains poorly understood. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, postnasal drip, and facial pain or pressure. Among the objectives of CRSwNP management are to eradicate nasal polyps from nasal and sinusal cavities, eliminate symptoms, and prevent recurrences. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating CRSwNP. Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical tre...

The Patient-Provider Relationship in Chronic Pain

Current Pain and Headache Reports — Tue, 24 Jan 2012 12:27:19 +0100

Abstract The relationship between patient and provider has long been the subject of study within the psychotherapy literature, with the available data suggesting a modest, but reliable, association between the strength of this relationship and treatment outcome. Conversely, there has been little work focused on the patient–provider relationship in chronic pain settings despite the complexities and difficulties that are often involved in this area. This review provides a brief, broad overview of the literature on the patient–provider relationship and identifies key aspects that are specifically relevant to chronic pain settings. In addition to reviewing the literature in this area, a series of recommendations for future clinical and academic work are offered. Conte...

Preferred place of care and place of death of the general public and cancer patients in Japan

Supportive Care in Cancer — Tue, 24 Jan 2012 07:34:11 +0100

In conclusion, establishing more accessible home and hospice service is strongly required through arranging regional resources to reduce family burden, alleviating patient-perceived burdens, and improving 24-h support at home. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00520-011-1373-8Authors Akemi Yamagishi, Department of Nursing, Seirei Christopher University, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka 433-8558, JapanTatsuya Morita, Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, JapanMitsunori Miyashita, Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, JapanSaran Yoshida, Department of Clinical Psycholo...

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Post-traumatic thoracic outlet syndrome

Acta Neurochirurgica — Tue, 24 Jan 2012 07:28:21 +0100

Conclusions The majority of patients suffering from a post-traumatic TOS present a neurogenic, usually subjective syndrome. Prompt therapeutic management is necessary, addressing both physical and psychological complaints. Most patients are cured or well improved by conservative and/or surgical treatment. Content Type Journal ArticleCategory Clinical ArticlePages 1-10DOI 10.1007/s00701-011-1269-xAuthors Annie Dubuisson, Department of Neurosurgery, CHU Liège, Domaine Universitaire du Sart Tilman, B 35, 4000 Liège, BelgiumCatherine Lamotte, Department of Physical Therapy, CHU, Liège, BelgiumMarguerite Foidart-Dessalle, Department of Physical Therapy, CHU, Liège, BelgiumMinh Nguyen Khac, Department of Neurosurgery, CHU Liège, Domaine Universitaire du Sart Tilman, ...

Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

CardioVascular and Interventional Radiology — Tue, 24 Jan 2012 06:48:21 +0100

Conclusions IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI. Content Type Journal ArticleCategory Clinical InvestigationPages 1-6DOI 10.1007/s00270-012-0342-zAuthors Mohsen Sharifi, Arizona Cardiovascular Consultants, 5440 E Southern Ave., Suite 104, Mesa, AZ 85206, USACurt Bay, Arizona School of Health Sciences, A.T. Still University, 5850 E Still Circle, Mesa, AZ 85206, USALaura Skrocki, Arizona Cardiovascular Consultants, 5440 E Southern Ave., Suite 104, Mesa, AZ 85206, USADavid Lawson, Arizona Cardiovascular Consultants, 5440 E Southern Ave., Suite 104, Mesa, AZ 85206, USAShahnaz Mazdeh, Arizona Cardiovascular Consultants, 5440 ...

Non-invasive imaging in acute chest pain syndromes

European Journal of Echocardiography — Tue, 24 Jan 2012 05:00:00 +0100

This review has the purpose of informing the reader about the current use of imaging techniques in patients presenting with acute chest pain to the emergency department. We will focus on three aspects of managing the patient with acute chest pain:Imaging to increase the number of correct diagnoses in the acute situation; Imaging to rule out other than coronary causes of chest pain; Use of imaging for risk stratification once myocardial infarction has been ruled out in the CPU. Special emphasis is given to how these management aspects are discussed in current guidelines on the management of patients with acute chest pain or acute coronary syndrome. (Source: European Journal of Echocardiography)

Attitudes, beliefs and self‐reported competence about postoperative pain among physicians and nurses working on surgical wards

Scandinavian Journal of Caring Sciences — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions: Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain. (Source: Scandinavian Journal of Caring Sciences)

Common and Less Common Peripheral Nerve Disorders Associated with Diabetes.

Current Diabetes Reviews — Tue, 24 Jan 2012 05:00:00 +0100

Authors: Knopp M, Rajabally YA Abstract Diabetes can be associated with a number of peripheral nerve disorders. The commonest is slowly-progressive axonal distal symmetrical sensori-motor neuropathy. Sensory loss and positive sensory symptoms are its main manifestations. Lumbosacral radiculoplexus neuropathy (LSRPN) is a distinct entity, accompanied by severe lumbar, hip, leg pain and weight loss, with subsequent weakness. Although typically unilateral, bilaterality is described, with spontaneous recovery usual over several months. The upper limb counterpart, cervical radiculoplexus neuropathy is rare. Acute painful neuropathies, including "diabetic neuropathic cachexia", are infrequent. Accompanying weight loss is usual and burning pains in the extremities are severe. Insulin-trig...

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Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

Advances in Pharmacological Sciences — Mon, 23 Jan 2012 18:36:31 +0100

In this report, we present a case of acute compartment syndrome of the right forearm in a 78 years old male patient following repeated attempts to secure an arterial line for initiating the thrombolytic therapy for the management of massive pulmonary embolism. The patient underwent urgent surgical decompression of the forearm compartments and thus managed to save his limb. (Source: Advances in Pharmacological Sciences)

Scales for the Evaluation of End-of-Life Care in Advanced Dementia: Sensitivity to Change

Alzheimer Disease and Associated Disorders — Mon, 23 Jan 2012 06:00:00 +0100

This study extends the psychometric properties of the EOLD scales by showing the sensitivity to clinically meaningful change in these scales to specific outcomes related to end-of-life care and quality of life among residents with end-stage advanced dementia and their HCPs. (C) 2012 Lippincott Williams & Wilkins, Inc. (Source: Alzheimer Disease and Associated Disorders)

Nursing leadership in a chronic pain management group approach

Journal of Nursing Management — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions The results show how important it is to have firm overall leadership and trained group leaders with a common purpose, interdependent roles and complementary skills, who are thus well prepared to prevent or deal with challenging group processes.Implications for nursing management The leaders of both levels, which are highly interrelated, should have a current theoretical understanding of pain theory, group leadership skills and a cognitive behavioural approach. (Source: Journal of Nursing Management)

A qualitative study on the role of cultural background in patients' perspectives on rehabilitation

BMC Musculoskeletal Disorders — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions: LBP rehabilitation can be improved by addressing the following points. Early management of LBP should be activity-centred instead of pain-centred. It is mandatory to implement return to work management early, including return to adapted work, to improve rehabilitation for patients. Rehabilitation has to start when patients have been off work for three months. Using interpreters more frequently would improve communication between health professionals and patients, and reduce misunderstandings about treatment procedures. Special emphasis must be put on the process of goal-formulation by spending more time with patients in order to identify barriers to goal attainment. Information on the return to work process should also include the financial aspects of unemployment and disabili...

Predictors of Headache Before, During, and After Pregnancy: A Cohort Study.

Headache — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions.- A history of headache prior to pregnancy is a strong predictor of headache during and after pregnancy, the latter independent of but compounded by spinal injection. Physicians should attend to prior headache history when making decisions about pain management during and after childbirth. As the lack of formal International Classification of Headache Disorders, 2nd Edition (ICHD-II), headache diagnoses is a limitation of this study, future longitudinal studies should replicate the present design while including headache subtyping consistent with ICHD-II nosology. PMID: 22268840 [PubMed - as supplied by publisher] (Source: Headache)

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"Governed by the pain": narratives of fibromyalgia.

Disability and Rehabilitation — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions: The narrative is characterized by a lack of movement and resolution, with participants engaged in an enduring struggle against the challenges of FM. Psychological approaches that facilitate this ongoing adjustment process may prove beneficial in FM treatment and rehabilitation. [Box: see text]. PMID: 22263672 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)

Inversion therapy in patients with pure single level lumbar discogenic disease: a pilot randomized trial.

Disability and Rehabilitation — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion: Intermittent traction with an inversion device resulted in a significant reduction in the need for surgery. A larger multicentre prospective randomized controlled trial is justified in patients with sciatica due to single level lumbar disc protrusions. [Box: see text]. PMID: 22263648 [PubMed - as supplied by publisher] (Source: Disability and Rehabilitation)

What Can Parents Do To Keep Their Children Safe on Playgrounds?

PediatricEducation.org — Mon, 23 Jan 2012 00:50:28 +0100

Discussion About 200,000 children are injured each year on playgrounds costing an estimated 1.2 billion dollars. Most of the playground injuries are at schools and daycare centers and gender rates and age rates depend on the study. More injuries occur in the summer months. Rates of severe injuries varies depending on classification and the specific study conducted. Fractures, lacerations, contusion/abrasion, and strains/sprains all are common injuries. Falls contribute to about 80% of injuries. Between 1990-2000, 147 children died from playground injuries – 82 from strangulation and 31 from falls. The number decreased from 2001-2008 to 40 deaths with 27 due to strangulation and 7 due to head injury. Climbing equipment and swings cause the most equipment-related injures. Learning Poin...

Practical aspects of metastatic castration‐resistant prostate cancer management: patient case studies

BJU International — Sat, 21 Jan 2012 12:44:18 +0100

• Interactive case studies formed a key feature of the third annual Interactive Genitourinary Cancer Conference held in April/May 2011 in Budapest, Hungary. These cases were used to discuss the practical aspects of the management of metastatic castration‐resistant prostate cancer (mCRPC). Particular emphasis was placed on audience participation with potential management options posed as interactive questions to the delegates. This paper summarises these case studies and the related discussion.• Docetaxel is the standard first‐line chemotherapeutic agent for patients with mCRPC and, until recently, second‐line therapeutic options were limited. Results from the recently completed TROPIC trial showed a statistically and clinically significant improvement in overall survival with...

One-Week and 3-Month Outcomes After an Emergency Department Visit for Undifferentiated Musculoskeletal Low Back Pain

Annals of Emergency Medicine — Fri, 20 Jan 2012 19:16:32 +0100

Conclusion: There is substantial short- and longer-term morbidity and ongoing analgesic use among patients who present to an ED with undifferentiated musculoskeletal low back pain. (Source: Annals of Emergency Medicine)

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Common Pain Options of Little Help for RA Patients (CME/CE)

MedPage Today Pain Management — Fri, 20 Jan 2012 11:13:08 +0100

(MedPage Today) -- Muscle relaxants and neuromodulators offered little pain relief for rheumatoid arthritis patients and cannot currently be recommended, according to two Cochrane reviews. (Source: MedPage Today Pain Management)

Major Public Health Campaign Called For By Stanford Dean To Fight Epidemic Of Unnecessary Suffering

Health News from Medical News Today — Fri, 20 Jan 2012 09:00:00 +0100

The amount of needless suffering caused by both acute and chronic pain in the United States is a major, overlooked medical problem that requires improved education at multiple levels, stretching from the implementation of new public health campaigns to better training of primary care physicians in pain management. "The magnitude of pain in the United States is astounding," write the authors of a perspective piece published in the New England Journal of Medicine. The article is co-authored by Philip Pizzo, MD, dean of the Stanford University School of Medicine... (Source: Health News from Medical News Today)

Operant Learning Theory in Pain and Chronic Pain Rehabilitation

Current Pain and Headache Reports — Fri, 20 Jan 2012 07:06:21 +0100

Abstract The application of operant learning theory on chronic pain by Fordyce has had a huge impact on chronic pain research and management. The operant model focuses on pain behaviors as a major component of the pain problem, and postulates that they are subject to environmental contingencies. The role of operant learning in pain behaviors generally has been supported by experimental studies, which are reviewed in the present article. Subsequently, the rationale, goals, and methods of operant behavioral treatment of chronic pain are outlined. Special attention is paid to three therapeutic techniques (graded activity, activity pacing, and time-contingent medication management), which are discussed in detail with regard to their operationalization, effectiveness, and (poss...

Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care. The ATLAS study protocol.

BMC Musculoskeletal Disorders — Fri, 20 Jan 2012 05:00:00 +0100

DiscussionThis prospective clinical observational cohort will combine self-reported data, comprehensive clinical and MRI assessment, together with qualitative enquiries, to describe the course, health care usage, patients' experiences and prognostic indicators in an adult population presenting in primary care with LBP and leg pain with or without nerve root involvement. (Source: BMC Musculoskeletal Disorders)

Very early diagnosis of chest pain by point-of-care testing: comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial

Heart — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion Measurement of cTnI alone is sufficient for diagnosis. Measurement of a marker panel does not facilitate diagnosis. (Source: Heart)

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Challenges in Making a Business Case for Effective Pain Management in Nursing Homes.

Journal of Gerontological Nursing — Fri, 20 Jan 2012 05:00:00 +0100

This article suggests several strategies for establishing an internal business case to support the implementation of a comprehensive pain management program in a nursing home setting. PMID: 22263554 [PubMed - as supplied by publisher] (Source: Journal of Gerontological Nursing)

Managing Rheumatoid Arthritis Pain With Muscle Relaxants And Neuromodulators

Health News from Medical News Today — Thu, 19 Jan 2012 08:00:00 +0100

Pain management is a high priority for patients with rheumatoid arthritis, so three researchers in Australia analysed existing study data to see whether two different classes of drugs can help. When looking at muscle relaxants, they discovered that neither the benzodiazepine agents, diazepam and triazolam, nor the non- benzodiazepine agent, zopiclone, reduce pain when taken for one to 14 days. However, even this short use was associated for both agents with drowsiness and dizziness... (Source: Health News from Medical News Today)

The Role of Exercise and Types of Exercise in the Rehabilitation of Chronic Pain: Specific or Nonspecific Benefits

Current Pain and Headache Reports — Thu, 19 Jan 2012 06:58:50 +0100

This article summarizes the types of exercise in the rehabilitation of chronic pain patients and provides practical recommendations for the clinician based on empirical and clinical experience. This safe, cost-free, nonpharmacologic way of managing pain has been found to reduce anxiety and depression, improve physical capacity, increase functioning and independence, and reduce morbidity and mortality. Content Type Journal ArticleCategory Psychiatric Management of Pain (MR Clark, Section Editor)Pages 1-9DOI 10.1007/s11916-012-0245-3Authors Amy Burleson Sullivan, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Mail Code U10, 9500 Euclid Avenue, Cleveland, OH 44195, USAJudith Scheman, Neurological Center for Pain, Cleveland Clinic, Mail Code C21, 9500 ...

Symptomatic and Palliative Care for Stroke Survivors

Journal of General Internal Medicine — Thu, 19 Jan 2012 06:51:08 +0100

We present the current and established data to aid health care providers in symptomatic and palliative management of stroke survivors. Content Type Journal ArticleCategory ReviewsPages 1-8DOI 10.1007/s11606-011-1966-4Authors Claire J. Creutzfeldt, Department of Neurology, University of Washington Harborview Medical Center, Box 359775, 325 Ninth Ave, Seattle, WA 98104-2499, USARobert G. Holloway, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USAMelanie Walker, Department of Neurology, University of Washington Harborview Medical Center, Box 359775, 325 Ninth Ave, Seattle, WA 98104-2499, USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734 (Source: Journal of General Internal Medicine)

Intranasal fentanyl in the treatment of acute pain – a systematic review

Acta Anaesthesiologica Scandinavica — Thu, 19 Jan 2012 05:00:00 +0100

The objective of this systematic review was to evaluate the current evidence of IN fentanyl in the treatment of acute pain. Reports of randomized controlled trials (RCTs) of IN fentanyl in treatment of pain were systematically sought using the PubMed database, Embase, Google scholar, Cochrane database, and Cumulative Index to Nursing and Allied Health Literature. Reports were considered for inclusion if they were double‐blinded randomized controlled trials (RCTs) of IN fentanyl in the treatment of acute pain. Thirty‐two RCTs were identified, and 16 were included in the final analysis. No significant analgesic differences between IN fentanyl and intravenous (IV) fentanyl were demonstrated in treatment of acute and post‐operative pain. Significant analgesic effect of IN fentanyl was de...

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Wound catheters for post‐operative pain management: overture or finale? Answer for letters to the editor

Acta Anaesthesiologica Scandinavica — Thu, 19 Jan 2012 05:00:00 +0100

(Source: Acta Anaesthesiologica Scandinavica)

Stereotactic body radiotherapy for the treatment of presacral recurrences from rectal cancers

Journal of Cancer Research and Therapeutics — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions: Stereotactic body radiotherapy for presacral recurrence of rectal adenocarcinoma is an efficacious and well-tolerated treatment modality which allows for palliation of pain. (Source: Journal of Cancer Research and Therapeutics)

Long-term sensitization of mechano-sensitive and -insensitive afferents in mice with persistent colorectal hypersensitivity.

American Journal of Physiology. Gastrointestinal and Liver Physiology — Thu, 19 Jan 2012 05:00:00 +0100

Authors: Feng B, La JH, Schwartz ES, Tanaka T, McMurray TP, Gebhart GF Abstract Afferent input contributes significantly to the pain and colorectal hypersensitivity that characterizes irritable bowel syndrome. We investigated in the present study the contributions of mechanosensitive and mechanically insensitive afferents (MIAs, or silent afferents) to colorectal hypersensitivity. The visceromotor response to colorectal distension (CRD; 15-60mmHg) was recorded in mice before and for weeks after intracolonic treatment with zymosan or saline. Following CRD tests, the distal colorectum with pelvic nerve attached was removed for single-fiber electrophysiological recordings. Colorectal afferent endings were located by electrical stimulation and characterized as mechanosensitive or not b...

Reframing eating during chemotherapy in cancer patients with chemosensory alterations.

European Journal of Oncology Nursing — Thu, 19 Jan 2012 05:00:00 +0100

CONCLUSION: To date, interventions to promote eating among cancer patients have focused extensively on symptom management and on recommendations for macro/micronutrient intake. This study underscores the importance of understanding beliefs about eating. These beliefs may help clinicians develop patient-centered nutritional interventions. PMID: 22265664 [PubMed - as supplied by publisher] (Source: European Journal of Oncology Nursing)

Diabetes and Adult Surgical InpatientsDiabetes and Adult Surgical Inpatients

Medscape Today Headlines — Thu, 19 Jan 2012 04:00:00 +0100

What steps should be taken to ensure safe management of diabetic surgical patients? Continuing Education in Anaesthesia, Critical Care & Pain (Source: Medscape Today Headlines)

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Intravenous Lidocaine for Management of Wound Care Pain