17 research outputs found
Cryoneurolysis for cervicogenic headache - A double blinded randomized controlled study
Background and aims: Cervicogenic headache (CEH) is a debilitating condition and analgesics have limited effect. Percutaneous cryoneurolysis is thus still in use although the clinical evidence is lacking. We present a randomized, controlled study to assess the clinical efficacy of cryoneurolysis compared with a corticosteroid combined with a local anaesthetic.
Methods: In a university-based outpatient pain clinic we performed a randomized, double blinded, comparative study with an 18-week follow-up. After positive diagnostic test blocks 52 eligible patients were randomly allocated in a ratio of 3:2, 31 participants to occipital cryoneurolysis and 21 participants to injections of 1 mL methylprednisolone 40 mg/mL (Depo-MedrolÂŽ) combined with 1 mL bupivacaine 5 mg/mL.
Results: We observed a significant pain reduction of more than 50% in both treatment groups, slightly improved neck function and reduced number of opioid consumers. After 6â7-weeks, however, pain intensity increased gradually, but did not reach baseline within 18 weeks. Although cryoneurolysis provided a more prolonged effect, the group differences did not reach statistical significance. Health related quality of life and psychological distress improved minimally. A large number reported minor and transient side effects, but we found no significant group differences. After 18 weeks, 29% rated the headache as much improved, and 12 (24%) somewhat improved, but a large proportion (78%) reported need for further intervention/treatment.
Conclusions: Cryoneurolysis provided substantial, but temporary pain relief, and the effect was not significantly different from injections of a corticosteroid combined with a local anaesthetic. Participants were selected by a single test block, and the neurolytic procedure was guided by anatomical landmarks and nerve stimulation. A stricter patient selection and an ultrasound-guided technique might have improved the results. Cryoneurolysis provides temporary pain relief not significantly superior to corticosteroid injection, and the results question the value of occipital cryoneurolysis for a chronic pain condition like CEH.
Implications: Occipital cryoneurolysis may be considered when non-invasive treatments appear insufficient, but only for patients who have responded substantially to test blocks. A risk of local scar and neuroma formation by repeated cryoneurolysis, leading to neuropathic pain has been discussed by other researchers.publishedVersio
Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study
Objectives: Although pain is a significant symptom in chronic fatigue syndrome (CFS), pain is poorly understood in adolescents with CFS. The aim of this study was to explore pain distribution and prevalence, pain intensity and its functional interference in everyday life, as well as pressure pain thresholds (PPT) in adolescents with CFS and compare this with a control group of healthy adolescents (HC). Methods: This is a caseâcontrol, cross-sectional study on pain including 120 adolescents with CFS and 39 HCs, aged 12â18â
years. We measured pain frequency, pain severity and pain interference using self-reporting questionnaires. PPT was measured using pressure algometry. Data were collected from March 2010 until October 2012 as part of the Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial. Results: Adolescents with CFS had significantly lower PPTs compared with HCs (p<0.001). The Pain Severity Score and the Pain Interference Score were significantly higher in adolescents with CFS compared with HCs (p<0.001). Almost all adolescents with CFS experienced headache, abdominal pain and/or pain in muscles and joints. Moreover, in all sites, the pain intensity levels were significantly higher than in HCs (p<0.001). Conclusions: We found a higher prevalence of severe pain among adolescents with CFS and lowered pain thresholds compared with HCs. The mechanisms, however, are still obscure. Large longitudinal population surveys are warranted measuring pain thresholds prior to the onset of CFS
Bipolar radiofrequency neurotomy for spinal pain - A promising technique but still some steps to go
Source at https://doi.org/10.1515/sjpain-2018-0305
Postoperative opioids and risk of respiratory depression - A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital
Objectives Opioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patientsâ safety regarding risk of respiratory depression. Methods The study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected. Results Two patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) ConclusionsThe lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression
I donât want to think about it: a qualitative study of children (6â18âyears) with rheumatic diseases and parentsâ experiences with regular needle injections at home
Background
Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living.
Methods
This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16âyears (nâ=â7) and their parents (nâ=â8) were interviewed individually 4 to 6âmonths after the onset of needle injection treatment. The focus groups included children aged 11 to 17âyears (nâ=â9) and parents (nâ=â8) with a minimum of 6âmonths of experience with injection treatment. Data were analyzed using thematic analysis.
Results
The main themes; âchallenges,â âmotivational factors,â and âroutinesâ captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The childrenâs experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet.
Conclusions
Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers
Responses after spinal interventions in a clinical pain practice â a pragmatic observational study
Children's fear of needle injections: A qualitative study of training sessions for children with rheumatic diseases before home administration
Childrenâs fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration
Background
Treatment of rheumatic diseases in children often includes long-term needle injections, which represent a risk for refusing medication based on potential needle-fear. How nurses manage childrenâs fear and pain during the initial educational training session of subcutaneous injections, may affect the management of the subsequent injections in the home settings. The aim of this study was to explore how children expressed fear and pain during these training sessions, and how adultsâ communication affected childrenâs expressed emotions.
Methods
This qualitative explorative study used video observations and short interviews during training sessions in a rheumatic hospital ward. Participants were children between five and fifteen years (nâ=â8), their parents (nâ=â11) and nurses (nâ=â7) in nine training sessions in total. The analysis followed descriptions of thematic analysis and interaction analysis.
Results
The children expressed fears indirectly as cues and nonverbal signs more often than direct statements. Three children stated explicit being afraid or wanting to stop. The children worried about needle-pain, but experienced the stinging pain after the injection more bothersome. The technical instructions were detailed and comprehensive and each nurse shaped the structure of the sessions. Both nurses and parents frequently offered coping strategies unclearly without sufficient time for children to understand. We identified three main adult communication approaches (acknowledging, ambiguous and disregarding) that influenced childrenâs expressed emotions during the training session.
Conclusions
Childrenâs expression of fear was likely to be indirectly, and pain was mostly related to the injection rather than the needle stick. When adults used an acknowledging communication and offered sufficient coping strategies, children seemed to become involved in the procedure and acted with confidence. The initial educational training session may have a great impact on long-term repeated injections in a home setting by providing children with confidence at the onset
Health related quality of life in adolescents with chronic fatigue syndrome: a cross-sectional study
Aim: To study health related quality of life (HRQOL) and depressive symptoms in adolescents with chronic fatigue
syndrome (CFS) and to investigate in which domains their HRQOL and depressive symptoms differ from those of
healthy adolescents.
Background and objective: Several symptoms such as disabling fatigue, pain and depressive symptoms affect
different life domains of adolescents with CFS. Compared to adolescents with other chronic diseases, young people
with CFS are reported to be severely impaired, both physiologically and mentally. Despite this, few have
investigated the HRQOL in this group.
Method: This is a cross-sectional study on HRQOL including 120 adolescents with CFS and 39 healthy controls (HC),
between 12 and 18 years. The Pediatric Quality of Life Inventoryâ˘, 4.0 (PedsQL) was used to assess HRQOL. The
Mood and Feelings Questionnaire assessed depressive symptoms. Data were collected between March 2010 and
October 2012 as part of the NorCAPITAL project (Norwegian Study of Chronic Fatigue Syndrome in Adolescents:
Pathophysiology and Intervention Trial). Linear and logistic regression models were used in analysis, and all tests
were two-sided.
Results: Adolescents with CFS reported significantly lower overall HRQOL compared to HCs. When controlling for
gender differences, CFS patients scored 44 points lower overall HRQOL on a scale from 0â100 compared to HCs.
The domains with the largest differences were interference with physical health (B = â59, 95 % CI â54 to â65) and
school functioning (B = â52, 95 % CI â45 to â58). Both depressive symptoms and being a patient were
independently associated with lower levels of HRQOL
Conclusion: The difference in HRQOL between CFS patients and healthy adolescents was even larger than we
expected. The large sample of adolescents with CFS in our study confirms previous findings from smaller studies,
and emphasizes that CFS is a seriously disabling condition that has a strong impact on their HRQOL. Even though
depressive symptoms were found in the group of patients, they could not statistically explain the poor HRQO
Health Related Quality of life in Adolescents with Chronic Fatigue Syndrome: A Cross-sectional Study
Aim To study health related quality of life (HRQOL) and depressive symptoms in adolescents with chronic fatigue syndrome (CFS) and to investigate in which domains their HRQOL and depressive symptoms differ from those of healthy adolescents.
Background and objective Several symptoms such as disabling fatigue, pain and depressive symptoms affect different life domains of adolescents with CFS. Compared to adolescents with other chronic diseases, young people with CFS are reported to be severely impaired, both physiologically and mentally. Despite this, few have investigated the HRQOL in this group.
Method This is a cross-sectional study on HRQOL including 120 adolescents with CFS and 39 healthy controls (HC), between 12 and 18 years. The Pediatric Quality of Life Inventoryâ˘, 4.0 (PedsQL) was used to assess HRQOL. The Mood and Feelings Questionnaire assessed depressive symptoms. Data were collected between March 2010 and October 2012 as part of the NorCAPITAL project (Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial). Linear and logistic regression models were used in analysis, and all tests were two-sided.
Results Adolescents with CFS reported significantly lower overall HRQOL compared to HCs. When controlling for gender differences, CFS patients scored 44 points lower overall HRQOL on a scale from 0â100 compared to HCs. The domains with the largest differences were interference with physical health (Bâ=ââ59, 95 % CI â54 to â65) and school functioning (Bâ=ââ52, 95 % CI â45 to â58). Both depressive symptoms and being a patient were independently associated with lower levels of HRQOL
Conclusion The difference in HRQOL between CFS patients and healthy adolescents was even larger than we expected. The large sample of adolescents with CFS in our study confirms previous findings from smaller studies, and emphasizes that CFS is a seriously disabling condition that has a strong impact on their HRQOL. Even though depressive symptoms were found in the group of patients, they could not statistically explain the poor HRQOL