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[PMID]:29049120
[Au] Autor:Abrecht CR; Brovman EY; Greenberg P; Song E; Rathmell JP; Urman RD
[Ad] Endereço:From the *Department of Anesthesia and Perioperative Care, Division of Pain Medicine, University of California San Francisco, San Francisco, California; †Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ‡Controlled Risk Insurance Company (CRICO) Strategies, Boston, Massachusetts; and §Harvard Medical School, Boston, Massachusetts.
[Ti] Título:A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain.
[So] Source:Anesth Analg;125(5):1761-1768, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to complement the existing closed claims literature by drawing on claims from a more recent timeframe through a partnership with a large malpractice carrier, the Controlled Risk Insurance Company (CRICO). The goal of this study was to identify patient medical comorbidities and aberrant drug behaviors, as well as prescriber practices associated with patient injury and malpractice claims. Another objective was to identify claims most likely to result in payments and use this information to propose a strategy for reducing medicolegal risk. METHODS: The CRICO Strategies Comparative Benchmarking System is a database of claims drawing from >350,000 malpractice claims from Harvard-affiliated institutions and >400 other academic and community institutions across the United States. This database was queried for closed claims from January 1, 2009, to December 31, 2013, and identified 37 cases concerning noninterventional, outpatient chronic pain management. Each file consisted of a narrative summary, including expert witness testimony, as well as coded fields for patient demographics, medical comorbidities, the alleged damaging event, the alleged injurious outcome, the total financial amount incurred, and more. We performed an analysis using these claim files. RESULTS: The mean patient age was 43.5 years, with men representing 59.5% of cases. Payments were made in 27% of cases, with a median payment of $72,500 and a range of $7500-$687,500. The majority of cases related to degenerative joint disease of the spine and failed back surgery syndrome; no patients in this series received treatment of malignant pain. Approximately half (49%) of cases involved a patient death. The use of long-acting opioids and medical conditions affecting the cardiac and pulmonary systems were more closely associated with death than with other outcomes. The nonpain medical conditions present in this analysis included obesity, obstructive sleep apnea, chronic obstructive pulmonary disease, hypertension, and coronary artery disease. Other claims ranged from alleged addiction to opioids from improper prescribing to alleged abandonment with withdrawal of care. The CRICO analysis suggested that patient behavior contributed to over half of these claims, whereas deficits in clinical judgment contributed to approximately 40% of the claims filed. CONCLUSIONS: Claims related to outpatient medication management in pain medicine are multifactorial, stemming from deficits in clinical judgment by physicians, noncooperation in care by patients, and poor clinical documentation. Minimization of both legal risk and patient harm can be achieved by carefully selecting patients for chronic opioid therapy and documenting compliance and improvement with the treatment plan. Medical comorbidities such as obstructive sleep apnea and the use of long-acting opioids may be particularly dangerous. Continuing physician education on the safest and most effective approaches to manage these medications in everyday practice will lead to both improved legal security and patient safety.
[Mh] Termos MeSH primário: Assistência Ambulatorial/legislação & jurisprudência
Analgésicos Opioides/efeitos adversos
Dor Crônica/prevenção & controle
Imperícia/legislação & jurisprudência
Erros Médicos/legislação & jurisprudência
Clínicas de Dor/legislação & jurisprudência
Padrões de Prática Médica/legislação & jurisprudência
Avaliação de Processos (Cuidados de Saúde)/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Assistência Ambulatorial/economia
Analgésicos Opioides/administração & dosagem
Causas de Morte
Dor Crônica/diagnóstico
Comorbidade
Compensação e Reparação/legislação & jurisprudência
Bases de Dados Factuais
Feminino
Seres Humanos
Seguro de Responsabilidade Civil/legislação & jurisprudência
Responsabilidade Legal
Masculino
Imperícia/economia
Erros Médicos/economia
Erros Médicos/mortalidade
Meia-Idade
Clínicas de Dor/economia
Medição da Dor
Segurança do Paciente
Padrões de Prática Médica/economia
Avaliação de Processos (Cuidados de Saúde)/economia
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002499


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[PMID]:28656659
[Au] Autor:Marin TJ; Van Eerd D; Irvin E; Couban R; Koes BW; Malmivaara A; van Tulder MW; Kamper SJ
[Ad] Endereço:Department of Psychology, York University, 209 Behavioural Sciences Building, 4700 Keele Street, Toronto, ON, Canada, M3J 1P3.
[Ti] Título:Multidisciplinary biopsychosocial rehabilitation for subacute low back pain.
[So] Source:Cochrane Database Syst Rev;6:CD002193, 2017 06 28.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low back pain (LBP) is associated with enormous personal and societal burdens, especially when it reaches the chronic stage of the disorder (pain for a duration of more than three months). Indeed, individuals who reach the chronic stage tend to show a more persistent course, and they account for the majority of social and economic costs. As a result, there is increasing emphasis on the importance of intervening at the early stages of LBP.According to the biopsychosocial model, LBP is a condition best understood with reference to an interaction of physical, psychological, and social influences. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.This review is an update of a Cochrane Review on MBR for subacute LBP, which was published in 2003. It is part of a series of reviews on MBR for musculoskeletal pain published by the Cochrane Back and Neck Group and the Cochrane Musculoskeletal Group. OBJECTIVES: To examine the effectiveness of MBR for subacute LBP (pain for a duration of six to 12 weeks) among adults, with a focus on pain, back-specific disability, and work status. SEARCH METHODS: We searched for relevant trials in any language by a computer-aided search of CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and two trials registers. Our search is current to 13 July 2016. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of adults with subacute LBP. We included studies that investigated a MBR program compared to any type of control intervention. We defined MBR as an intervention that included a physical component (e.g. pharmacological, physical therapy) in combination with either a psychological, social, or occupational component (or any combination of these). We also required involvement of healthcare professionals from at least two different clinical backgrounds with appropriate training to deliver the component for which they were responsible. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. In particular, the data extraction and 'risk of bias' assessment were conducted by two people, independently. We used the Cochrane tool to assess risk of bias and the GRADE approach to assess the overall quality of the evidence for each outcome. MAIN RESULTS: We included a total of nine RCTs (981 participants) in this review. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years.All included studies were judged as having high risk of performance bias and high risk of detection bias due to lack of blinding, and four of the nine studies suffered from at least one additional source of possible bias.In MBR compared to usual care for subacute LBP, individuals receiving MBR had less pain (four studies with 336 participants; SMD -0.46, 95% CI -0.70 to -0.21, moderate-quality of evidence due to risk of bias) and less disability (three studies with 240 participants; SMD -0.44, 95% CI -0.87 to -0.01, low-quality of evidence due to risk of bias and inconsistency), as well as increased likelihood of return-to-work (three studies with 170 participants; OR 3.19, 95% CI 1.46 to 6.98, very low-quality of evidence due to serious risk of bias and imprecision) and fewer sick leave days (two studies with 210 participants; SMD -0.38 95% CI -0.66 to -0.10, low-quality of evidence due to risk of bias and imprecision) at 12-month follow-up. The effect sizes for pain and disability were low in terms of clinical meaningfulness, whereas effects for work-related outcomes were in the moderate range.However, when comparing MBR to other treatments (i.e. brief intervention with features from a light mobilization program and a graded activity program, functional restoration, brief clinical intervention including education and advice on exercise, and psychological counselling), we found no differences between the groups in terms of pain (two studies with 336 participants; SMD -0.14, 95% CI -0.36 to 0.07, low-quality evidence due to imprecision and risk of bias), functional disability (two studies with 345 participants; SMD -0.03, 95% CI -0.24 to 0.18, low-quality evidence due to imprecision and risk of bias), and time away from work (two studies with 158 participants; SMD -0.25 95% CI -0.98 to 0.47, very low-quality evidence due to serious imprecision, inconsistency and risk of bias). Return-to-work was not reported in any of the studies.Although we looked for adverse events in both comparisons, none of the included studies reported this outcome. AUTHORS' CONCLUSIONS: On average, people with subacute LBP who receive MBR will do better than if they receive usual care, but it is not clear whether they do better than people who receive some other type of treatment. However, the available research provides mainly low to very low-quality evidence, thus additional high-quality trials are needed before we can describe the value of MBP for clinical practice.
[Mh] Termos MeSH primário: Dor Aguda/reabilitação
Dor Lombar/reabilitação
[Mh] Termos MeSH secundário: Dor Aguda/psicologia
Adulto
Terapia Combinada
Seres Humanos
Dor Lombar/psicologia
Clínicas de Dor
Medição da Dor
Ensaios Clínicos Controlados Aleatórios como Assunto
Recuperação de Função Fisiológica
Retorno ao Trabalho/estatística & dados numéricos
Licença Médica/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD002193.pub2


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[PMID]:28477765
[Au] Autor:Gautier JM; Le Chevalier A
[Ad] Endereço:CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France. Electronic address: jm-gautier@chu-montpellier.fr.
[Ti] Título:[Territorial resources and access to care in the case of chronic pain].
[Ti] Título:Ressources territoriales et accès aux soins en cas de douleur chronique..
[So] Source:Soins;62(815):51-53, 2017 May.
[Is] ISSN:0038-0814
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:To respond to the complexity of the management of patients with chronic pain, an adapted and structured biopsychosocial approach is necessary. Created and managed by committed caregivers, regulated and financed by decision-making bodies, chronic pain assessment and treatment centres form part of the patient care pathway.
[Mh] Termos MeSH primário: Dor Crônica/enfermagem
Dor Crônica/psicologia
Procedimentos Clínicos
Recursos em Saúde
Acesso aos Serviços de Saúde
Manejo da Dor/enfermagem
[Mh] Termos MeSH secundário: Terapia Combinada/enfermagem
Procedimentos Clínicos/organização & administração
França
Recursos em Saúde/organização & administração
Acesso aos Serviços de Saúde/organização & administração
Seres Humanos
Programas Nacionais de Saúde/organização & administração
Clínicas de Dor/organização & administração
Manejo da Dor/psicologia
Equipe de Assistência ao Paciente/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170508
[St] Status:MEDLINE


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[PMID]:28376851
[Au] Autor:Dubois J; Scala E; Faouzi M; Decosterd I; Burnand B; Rodondi PY
[Ad] Endereço:Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010, Lausanne, Switzerland. Julie.Dubois@chuv.ch.
[Ti] Título:Chronic low back pain patients' use of, level of knowledge of and perceived benefits of complementary medicine: a cross-sectional study at an academic pain center.
[So] Source:BMC Complement Altern Med;17(1):193, 2017 Apr 04.
[Is] ISSN:1472-6882
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Chronic pain patients often use complementary medicine (CM) to alleviate their pain; however, little is known about the use of CM by chronic low back pain (cLBP) patients. We investigated the frequency of use of CM by cLBP patients, the perceived effects of these therapies, patients' knowledge regarding CM, and patient-physician communication regarding CM. METHOD: A cross-sectional survey was conducted from November 2014 to February 2015. A questionnaire was distributed by physicians to 238 consecutive patients consulting for cLBP at the Pain Center of Lausanne University Hospital, Switzerland. Poisson regression model was used to analyze patients' level of knowledge regarding various CMs, and the logistic regression model was used to assess CM use for cLBP. RESULTS: The questionnaire was returned by 168 cLBP patients (response rate: 70.6%). Lifetime prevalence of CM use for cLBP was 77.3%. The most commonly used therapies were osteopathy (48.8%), massage (45.2%) and acupuncture (31.6%), rated for their usefulness on a 0-10 scale as a mean ± SD of 5.4 ± 2.7, 5.9 ± 2.5 and 3.8 ± 3.2, respectively. The CM treatment best known by patients was osteopathy, followed by massage and acupuncture. If their doctors proposed CM as a treatment for cLBP, 78% of participants reported being very or somewhat likely to try CM. Respondents with CM health insurance were more likely to use CM (OR = 2.26; 95%CI: 1.07-4.78; p = 0.031) for cLBP. Respondents having experienced cLBP for more than five years were more likely to use CM to treat their cLBP than respondents having experienced cLBP for one year or less (OR = 2.84; 95%CI: 1.02-7.88; p = 0.044). CONCLUSIONS: More than three-quarters of cLBP patients in our sample did use CM to treat their cLBP. The results showed that the most commonly used therapies were not necessarily the highest rated in terms of perceived usefulness. These results highlight the importance of developing integrative pain centers in which patients may obtain advice regarding CM treatments.
[Mh] Termos MeSH primário: Terapias Complementares
Dor Lombar/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Dor Crônica/terapia
Estudos Transversais
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Masculino
Meia-Idade
Clínicas de Dor
Inquéritos e Questionários
Suíça
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170425
[Lr] Data última revisão:
170425
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE
[do] DOI:10.1186/s12906-017-1708-1


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[PMID]:28277318
[Au] Autor:Odonkor CA; Christiansen S; Chen Y; Sathiyakumar A; Chaudhry H; Cinquegrana D; Lange J; He C; Cohen SP
[Ad] Endereço:From the Departments of *Physical Medicine & Rehabilitation, †Anesthesiology & Critical Care Medicine, and ‡Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; and Departments of §Anesthesiology and ‖Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
[Ti] Título:Factors Associated With Missed Appointments at an Academic Pain Treatment Center: A Prospective Year-Long Longitudinal Study.
[So] Source:Anesth Analg;125(2):562-570, 2017 Aug.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Interventional pain treatment centers represent an integral part of interdisciplinary care. Barriers to effective treatment include access to care and financial issues related to pain clinic operations. To address these challenges, specialty clinics have taken steps to identify and remedy missed clinic appointments. However, no prospective study has sought to identify factors associated with pain clinic "no-shows." METHODS: We performed a prospective, longitudinal year-long study in an inner-city, academic pain clinic in which patients scheduled for office visits and procedures were categorized as to whether they showed up or did not show up for their scheduled appointment without cancelling the day before. Twenty demographic (age, employment status), clinical (eg, diagnosis, duration of pain), and environmental (season, time and day of appointment) variables were assessed for their association with missing an appointment. The logistic regression model predicting no-shows was internally validated with crossvalidation and bootstrapping methods. A predictive nomogram was developed to display effect size of predictors for no-shows. RESULTS: No-show data were collected on 5134 patients out of 5209 total appointments for a capture rate of 98.6%. The overall no-show rate was 24.6% and was higher in individuals who were young (<65 years), single, of ethnic minority background, received Medicare/Medicaid, had a primary diagnosis of low back pain or headaches, were seen on a day with rain or snow or for an initial consult, and had at least 1 previous pain provider. Model discrimination (area under curve) was 0.738 (99% confidence interval, 0.70-0.85). A minimum threshold of 350 points on the nomogram predicted greater than 55% risk of no-shows. CONCLUSIONS: We found a high no-show rate, which was associated with predictable and unpredictable (eg, snow) factors. Steps to reduce the no-show rate are discussed. To maximize access to care, operation managers should consider a regression model that accounts for patient-level risk of predictable no-shows. Knowing the patient level, no-show rate can potentially help to optimize the schedule programming by staggering low- versus high-probability no-shows.
[Mh] Termos MeSH primário: Agendamento de Consultas
Clínicas de Dor
Cooperação do Paciente
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Idoso
Instituições de Assistência Ambulatorial
Baltimore
Grupos Étnicos
Feminino
Cefaleia/terapia
Acesso aos Serviços de Saúde
Seres Humanos
Estudos Longitudinais
Dor Lombar/terapia
Masculino
Medicaid
Medicare
Meia-Idade
Nomogramas
Manejo da Dor/métodos
Estudos Prospectivos
Análise de Regressão
Risco
Fatores de Tempo
Estados Unidos
População Urbana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001794


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[PMID]:28261783
[Au] Autor:Montes A; Aguilar JL; Benito MC; Caba F; Margarit C; Acute Pain Group of the Spanish Pain Society (SED)
[Ad] Endereço:Pain Clinic, Department of Anaesthesiology, Parc de Salut MAR, Fundació IMIM, Neurosciences Programme, Perioperative Medicine Research Group, Universitat Autònoma de Barcelona, Barcelona, Spain.
[Ti] Título:Management of postoperative pain in Spain: a nationwide survey of practice.
[So] Source:Acta Anaesthesiol Scand;61(5):480-491, 2017 May.
[Is] ISSN:1399-6576
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although the need for structured assessment and management of acute postoperative pain has been recognized, practices and responsibilities vary between and within hospitals and countries. We sought to determine current pain management practices in Spanish hospitals with and without acute pain services (APSs) or acute pain management programmes (APMPs) and compare them to practices reported for 1997-1998. METHODS: Members of the Spanish Pain Society and APS/APMP heads were asked to respond to a survey. Responses were stratified by hospital size (< 200 or ≥ 200 beds) and APS/APMP presence or not. Categorical variables were described by percentages and the 95% confidence interval and continuous ones by the median and interquartile range. RESULTS: Responses were received from 42.4% of hospitals with ≥ 200 beds (vs. 9.6% of the smaller ones). We fully analysed only data for the larger hospitals, 57.7% of which had an APS or APMP. Full-time pain physicians were on staff in 28.6% of large hospitals; 25% had full-time nurses. Patients received written information about postoperative pain in 34.8% of APS/APMP hospitals, and 72% of them recorded pain assessments routinely. Protocols reflected interdepartmental consensus in 80.8%; training in postoperative pain was organised in 54%. Respondents thought pain was well or very well managed in 46.4%. In APS/APMP hospitals the following results had improved: provision of written information for patients (58.5% vs. 0%), the recording of pain assessments (93% vs. 43.8%), consensus on a pain scale (92.5% vs. 41.9%), use of protocols (99.7% vs. 55.2%), analysis of quality indicators (52.8% vs. 15.4%), training (73% vs. 26.9%), and respondents' satisfaction with pain management in their hospital (68.6% vs. 9.5%). CONCLUSIONS: The presence of an APS or APMP is associated with better results on indicators of quality of acute postoperative pain management.
[Mh] Termos MeSH primário: Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
Hospitais/estatística & dados numéricos
Manejo da Dor/métodos
Manejo da Dor/estatística & dados numéricos
Dor Pós-Operatória/terapia
[Mh] Termos MeSH secundário: Seres Humanos
Clínicas de Dor/estatística & dados numéricos
Espanha
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE
[do] DOI:10.1111/aas.12876


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[PMID]:28220730
[Au] Autor:Tarloff D; Lamacraft G; Joubert G
[Ad] Endereço:Department of Anaesthesiology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa. debstarloff@yahoo.com.
[Ti] Título:The prevalence of skin scars in patients previously given intramuscular diclofenac injections attending the Pain Clinic at Universitas Academic Hospital, Bloemfontein, South Africa.
[So] Source:S Afr Med J;107(2):101-105, 2017 Jan 30.
[Is] ISSN:0256-9574
[Cp] País de publicação:South Africa
[La] Idioma:eng
[Ab] Resumo:Intramuscular (IM) diclofenac rarely causes scarring (reported incidence <0.05%). Some patients attending the Pain Clinic at Universitas Academic Hospital, Bloemfontein, South Africa, presented with scars that had developed after IM diclofenac injections. We investigated the prevalence of scars in patients at the clinic and how the injections had been obtained. Patients attending the clinic over a period of 9 months who said they had received diclofenac (N=131) were included. Information was collected using a questionnaire and physical examination. Data obtained from 118 patients who were certain that they had received diclofenac were analysed. Ninety-three patients (78.8%) indicated they had not been warned about the possibility that a diclofenac injection could result in scarring. Scarring had occurred in 10 patients (8.5%). Two-thirds of the patients who had obtained diclofenac from a pharmacy had never had a prescription for it. Four patients had required medical treatment for an ulcer or abscess, of whom two had undergone surgery. The risk of skin lesions associated with IM diclofenac is higher than reported previously. Contrary to regulations, diclofenac injections were often dispensed to patients without a prescription.
[Mh] Termos MeSH primário: Anti-Inflamatórios não Esteroides/administração & dosagem
Cicatriz/epidemiologia
Diclofenaco/administração & dosagem
Injeções Intramusculares/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Cicatriz/etiologia
Prescrições de Medicamentos/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Clínicas de Dor
Prevalência
Estudos Prospectivos
África do Sul/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal); 144O8QL0L1 (Diclofenac)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170222
[St] Status:MEDLINE
[do] DOI:10.7196/SAMJ.2017.v107i2.12012


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[PMID]:28183583
[Au] Autor:Kanai A; Matsumoto S; Hayashi N; Shimao J; Nagahara Y
[Ad] Endereço:Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan. Electronic address: kanaiakifumi@aol.com.
[Ti] Título:Visual/emotional stimuli and treatment with antidepressants alter Numerical Rating Scale score in patients with chronic pain.
[So] Source:J Clin Anesth;36:90-93, 2017 Feb.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: To examine the impact of visual stimulation (exciting red and tranquilizing green) on the score of the Numerical Rating Scale (NRS) questionnaire in patients with chronic pain. DESIGN: Prospective randomized study. SETTING: Outpatient pain clinic of a university hospital. PATIENTS: Two hundred outpatients with chronic pain. INTERVENTIONS: Patients were randomly assigned to receive the NRS questionnaire printed on either red paper (red group) or green paper (green group). MEASUREMENTS: The questionnaire included 5 questions consisting of the NRS in the worst, in the least, and in the average pain during last week and the NRS at rest and on movement at present. Calculation of the sample size was based on power of 0.8 and α=.01. MAIN RESULTS: The NRS scores were not different between the 2 groups. In patients on antidepressants (n=76) and with depression (n=49), the NRS scores, except the NRS in the worst pain during last week score in patients on antidepressants, were significantly higher in the red group than in the green group (all P≤.040). In the red group, the NRS scores were significantly higher in patients with than without depression (all P≤.003), whereas there was no difference in the scores between patients of the green group with and without depression. CONCLUSION: Our findings suggest that visual/emotional stimuli and treatment with antidepressants alter the NRS score in patients with chronic pain.
[Mh] Termos MeSH primário: Antidepressivos/uso terapêutico
Dor Crônica/diagnóstico
Medição da Dor/métodos
Estimulação Luminosa/métodos
[Mh] Termos MeSH secundário: Idoso
Dor Crônica/psicologia
Cor
Depressão/tratamento farmacológico
Depressão/psicologia
Emoções
Feminino
Seres Humanos
Masculino
Meia-Idade
Clínicas de Dor
Manejo da Dor/métodos
Medição da Dor/psicologia
Estudos Prospectivos
Método Simples-Cego
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antidepressive Agents)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170211
[St] Status:MEDLINE


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[PMID]:28067939
[Au] Autor:Leuter C; Piroli A; Paladini A; Tudini M; Varrassi G
[Ad] Endereço:Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
[Ti] Título:Care strategies and therapeutic pathways for chronic pain patients in Abruzzo Region, Italy.
[So] Source:Ann Ig;29(1):63-72, 2017 Jan-Feb.
[Is] ISSN:1120-9135
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Chronic pain is considered to be among the most disabling and costly diseases in North America, Europe and Australia. A large survey was conducted on chronic pain in Europe, called Pain in Europe. Italy ranks third in Europe in terms of prevalence, with 26% of the population suffering from chronic pain at some point. In 2010 Italy passed Law 38/2010, to ensure treatment for pain control in patients with oncological diseases as well as in patients with chronic non-cancer pain through a network of care services. This study aims to provide preliminary information regarding the application of L.38/2010 in the Abruzzo region of Italy. METHODS: A descriptive study was conducted on a non-probabilistic sample of people who attended pain therapy centres of the local health service in 2014. The patients (129) were interviewed by centre staff using a validated questionnaire. Recruitment was carried out by enrolling consecutive cases over a three-month period (February to April). RESULTS: Almost two-thirds of the patients had visited several physicians before requesting help. The initial visit to the pain therapy centre was made after some months in 37.2% of cases, and in 38% of patients it was made years after the onset of pain. The reasons given for this long wait before seeking specialist medical treatment for chronic pain reveal a wait-and-see attitude on the part of patients, who controlled their pain by taking painkillers. Responsibility for this delay in requesting assistance can however also be attributed 'externally' to the fact that patients were not aware that this kind of centre was available. CONCLUSION: The results of the study describe, in a regional context, a situation in which L.38/2010 is hard to apply. The study showed how the care pathway for these patients is still characterised by difficulty in accessing the network of local services. Clearly, more effort needs to be directed towards an effective application of L.38/2010, with increased availability of resources to develop and strengthen the network of services at regional level.
[Mh] Termos MeSH primário: Doença Crônica/epidemiologia
Dor Crônica/epidemiologia
Dor Crônica/terapia
Neoplasias/epidemiologia
Clínicas de Dor/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Dor Crônica/etiologia
Europa (Continente)/epidemiologia
Feminino
Seres Humanos
Itália/epidemiologia
Masculino
Meia-Idade
Neoplasias/complicações
Clínicas de Dor/legislação & jurisprudência
Prevalência
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170619
[Lr] Data última revisão:
170619
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170110
[St] Status:MEDLINE
[do] DOI:10.7416/ai.2017.2133


  10 / 1317 MEDLINE  
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[PMID]:27794636
[Au] Autor:Ross E
[Ad] Endereço:Pain Management Center, Brigham & Women's Hospital, Boston, MA, USA.
[Ti] Título:Brigham and Women's Hospital three-time winner of the American Pain Society Clinical Centers of Excellence Award.
[So] Source:Pain Manag;7(1):11-13, 2017 Jan.
[Is] ISSN:1758-1877
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Edgar Ross speaks to Jade Parker, Commissioning Editor: Dr Edgar Ross is a member of the Anesthesia Department at Brigham and Women's Hospital. His main office is in Chesnut Hill, an ambulatory care center for Brigham and Women's hospital. He received his medical degree from Wayne State University School of Medicine and has been in practice for more than 30 years, 20 years in his current position at Brigham and Women's Hospital. His two main clinical interests are; the phone app which is designed to become the main clinical tool for patients and second, the relationship between opioids and angiogenesis.
[Mh] Termos MeSH primário: Dor Crônica/terapia
Clínicas de Dor/organização & administração
Manejo da Dor
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Distinções e Prêmios
[Pt] Tipo de publicação:INTERVIEW
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170302
[Lr] Data última revisão:
170302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161101
[St] Status:MEDLINE



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