The problem of the bleeding state

The problem of the patient who bleeds excessively or alleges he bleeds abnormally, is a familiar one. In some cases the bleeding state may be obvious, since purpura, easy bruising or excessive haemorrhage direct one's attention to it. Sometimes when there is a local lesion it may be difficult to know whether to ascribe the bleeding to local or general causes. A patient, for instance, who presents with epistaxis, may have a local lesion in the nose or a generalized bleeding disease, or both these conditions. Patients with haematuria, haematemesis or melaena may present similar problems

Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography

BACKGROUND: People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this paper is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain. METHODS: A systematic literature review was undertaken of published and unpublished literature databases including: EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme (CASP) qualitative appraisal tool. RESULTS: From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals, role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient’s condition; knowledge and skills to provide caregiving; and the perception of other family members and wider-society to the caregiver/care recipient dyad. CONCLUSIONS: The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad’s lived experience is now warranted

Systematic review of the behavioural assessment of pain in cats

Objectives The objectives were to review systematically the range of assessment tools used in cats to detect the behavioural expression of pain and the evidence of their quality; and to examine behavioural metrics (considering both the sensory and affective domains) used to assess pain. Methods A search of PubMed and ScienceDirect, alongside articles known to the authors, from 2000 onwards, for papers in English was performed. This was followed by a manual search of the references within the primary data sources. Only peer-reviewed publications that provided information on the assessment tool used to evaluate the behavioural expression of pain in cats, in conscious animals (not anaesthetised cats), were included. Results No previous systematic reviews were identified. One hundred papers were included in the final assessment. Studies were primarily related to the assessment of pain in relation to surgical procedures, and no clear distinction was made concerning the onset of acute and chronic pain. Ten broad types of instrument to assess pain were identified, and generally the quality of evidence to support the use of the various instruments was poor. Only one specific instrument (UNESP-Botucatu scale) had published evidence of validity, reliability and sensitivity at the level of a randomised control trial, but with a positive rather than placebo control, and limited to its use in the ovariohysterectomy situation. The metrics used within the tools appeared to focus primarily on the sensory aspect of pain, with no study clearly discriminating between the sensory and affective components of pain. Conclusions and relevance Further studies are required to provide a higher quality of evidence for methods used to assess pain in cats. Furthermore, a consistent definition for acute and chronic pain is needed. Tools need to be validated that can detect pain in a range of conditions and by different evaluators (veterinary surgeons and owners), which consider both the sensory and emotional aspects of pain

Avaliação das diferenças de gênero nas estratégias de enfrentamento da dor lombar

El dolor lumbar puede ser visto como un gran problema de salud pública. Las diferencias de género son importantes factores que influyen en los síntomas y en las respuestas del comportamiento. El objetivo de este estudio fue investigar las diferencias de género en los comportamientos de dolor y en el manejo del dolor lumbar crónico. La muestra estuvo conformada por 158 participantes (66,5% mujeres), con edades entre los 30 y 88 años que fueron diagnosticados con artrosis lumbar. Los instrumentos utilizados fueron: la Escala Visual Analógica, el Cuestionario de Calidad de Vida y un cuestionario para evaluar las actividades de ocio y distracción del dolor. Los resultados del MANOVA demostraron que las mujeres presentaron mayor percepción del dolor que los hombres. También fue posible observar frecuencias más altas de actividades sociales en las mujeres, así como correlaciones significativas entre las actividades sociales y los dominios psicológicos, sociales y medio ambientales. En conclusión, las mujeres presentan un mayor número de estrategias de afrontamiento para el dolor, lo cual puede influir positivamente en su calidad de vida.A dor lombar pode ser vista como um grande problema de saúde pública. As diferenças de gênero são importantes fatores que influenciam nos sintomas e nas respostas do comportamento. O objetivo deste estudo foi pesquisar as diferenças de gênero nos comportamentos de dor e na gestão da dor lombar crônica. A amostra foi conformada por 158 participantes (66,5% mulheres), com idade entre 30 e 88 anos, que foram diagnosticadas com artrose lombar. Os instrumentos utilizados foram: a Escala Visual Analógica, o Questionário de Qualidade de Vida e um questionário para avaliar as atividades de lazer e distração da dor. Os resultados do MANOVA demonstraram que as mulheres apresentaram maior percepção da dor do que os homens. Também foi possível observar frequências mais altas de atividades sociais nas mulheres, bem como correlações significativas entre as atividades sociais e os domínios psicológicos, sociais e meio ambientais. Em conclusão, as mulheres apresentaram um maior número de estratégias de enfrentamento para a dor, o que pode influenciar positivamente em sua qualidade de vida.Low-back pain is considered a serious public health problem. Gender differences are important factors that influence symptoms and behavioral responses. This research aimed to investigate gender differences in pain behaviors and pain management of chronic low back pain. The sample consisted of 158 participants (66.5% female), aged 30-88 who were diagnosed with Lumbar Osteoarthritis. The instruments used were the Visual Analogue Scale, the Quality of Life Questionnaire and a questionnaire to assess leisure and distraction activities from pain. Results of MANOVA showed that women have significant greater pain perception than men. Higher frequencies of social activities were also observed for women as well as significant correlations between social activities and psychological, social and environmental domains. In conclusion, women presented a greater number of coping strategies for pain than men, which probably tend to have a positive influence in their life quality

Does the IASP Definition of Pain Need Updating?

The current IASP definition of pain has come under renewed criticisms recently. There is a new momentum for its revision as reflected by the fact that IASP has now a Presidential Task Force dedicated to look into whether there is enough warrant to update the definition. I critically review all the major criticisms of the current definition in detail, and raise new difficulties rarely discussed before. I show that none of the major criticisms has enough warrant to force us to substantially revise the current definition. Combined with the discussion of the new difficulties, there is nonetheless a need to restate the definition using slightly different terminology that will make the original intent of the current definition clearer and more precise. A restatement of the definition is proposed and its potential is discussed in light of some empirical questions that remain. [The IASP Council has now approved a revised definition and published its rationale here: Pain 2020 Sep 1; 161(9), pp. 1976–1982.

Current dilemmas in the assessment of suffering in palliative care

ABSTRACT: Although relief from suffering is essential in healthcare and palliative care, few efforts have aimed at defining, operationalizing, and developing standards for its detection, assessment, and relief. In order to accurately explore and identify factors that contribute to suffering, more attention needs to be focused on quality assessment and measurement, not only for assessment purposes but also to test the effectiveness of interventions in relieving suffering. The scope of the present paper is to discuss the strategies that aid in the detection and assessment of the suffering experience in patients with chronic illnesses and/or in palliative care settings, and the dilemmas commonly encountered regarding the quality of available assessment measures. Method: A general description of instruments available for suffering assessment is provided. Matters regarding the accuracy of the measures are discussed. Finally, some dilemmas regarding the quality of the measures to screen for and assess suffering are presented. Results: There have been some achievements toward adequate suffering assessment. However, a more robust theoretical background is needed, and empirical evidence aimed at supporting it is required. In addition, further examination of the psychometric characteristics of instruments in different populations and cultural contexts is needed. Significance of results: An interesting number of assessment measures are now available for use in the palliative care setting, employing innovative approaches. However, further examination and validation in different contexts is required to find high-quality tools for detection of suffering and assessment of the results of intervention