scholarly journals A Case Report on Chronic Intestinal Pseudo-obstruction Presenting as Unspecified Abdominal Pain in an Adult

2021 ◽  
Vol 42 (5) ◽  
pp. 1094-1101
Author(s):  
Yu-bin Ha ◽  
Han-sol Jang ◽  
Gil-cho Shin
Keyword(s):  
Abdominal Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
The Body ◽  
X Rays ◽  
Treatment Progress ◽  
Numerical Rating ◽  
Intestinal Pseudo Obstruction ◽  
Fluid Levels

Objectives: This study examined a case of chronic intestinal pseudo-obstruction (CIPO) in an adult with unspecified abdominal pain.Methods: The patient was treated with herbal medicine, acupuncture, and moxa. Treatment progress was evaluated by follow-up monitoring of the intensity, frequency, and duration (in hours) of abdominal pain and body weight.Results: The average abdominal pain level on the Numerical Rating Scale (NRS) and its incidence decreased. The duration of pain was 15 hours maximum and 2.5 hours minimum. The body weight repeatedly increased and decreased but increased overall. Despite no remarkable findings from X-rays, air-fluid levels and coil-shaped folds of the small bowel were observed.Conclusions: Korean medical treatment based on a dialectic effectively relieved chronic abdominal pain and suspected CIPO-a disease that requires continuous management and therapeutic intervention.

scholarly journals Percutaneous Osteoplasty under Fluoroscopy and Cone-Beam CT guidance for Painful Sternal Metastases

2021 ◽  
Author(s):  
Xun-wei Liu ◽  
Zhi-guo Wang ◽  
Jin Peng ◽  
Gang Sun
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Cone Beam Ct ◽  
Tumor Location ◽  
Cone Beam ◽  
Ct Guidance ◽  
Numerical Rating ◽  
Cement Distribution ◽  
Painful Bone Metastases

Abstract Background: Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine, there are only scarced reports regarding osteoplasty in painful sternal metastases.Case presentation: The paper reported four patients with painful sternal metastasis who underwent POP under fluoroscopic and cone-beam CT guidance. The patients were three men and one woman (mean age, 66.25 years). Primary tumor location in lung is 3 cases, in thyroid is 1 case. In these cases, Pain was measured using a numerical rating scale (NRS), with scores ranging from 0 (no pain) to 10 (worst pain imaginable). The scores on the NRS in the four patients before POP were 9, 8, 8, and 9. After POP, the NRS scores decreased to 2, 3, 2, and 2, respectively, in follow-up at 6 months. Conclusions: POP is a safe and effective treatment for pain caused by metastatic bone tumors in the sternum. However, care and at tention should be paid to the insertion of a needle and cement distribution for better treatment effect

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

scholarly journals The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis

2016 ◽  
Vol 11 (4) ◽  
pp. 1208-1213 ◽  
Author(s):  
Omer A. Raheem ◽  
Sunil H. Patel ◽  
David Sisul ◽  
Tim J. Furnish ◽  
Tung-Chin Hsieh
Keyword(s):  
Chronic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Opioid Therapy ◽  
Total Testosterone ◽  
Chronic Noncancer Pain ◽  
Numerical Rating ◽  
Noncancer Pain ◽  
Supplemental Therapy

Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups ( p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group ( p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.

scholarly journals Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

2020 ◽  
Vol 37 (3) ◽  
pp. 187-192
Author(s):  
Ga Hyeon Jung ◽  
Hyun Lee ◽  
Hwa Yeon Ryu ◽  
Jae Hui Kang
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Insufficiency Fracture ◽  
Sacral Insufficiency Fracture ◽  
Korean Medicine ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
History Of ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study

2013 ◽  
Vol 38 (8) ◽  
pp. 866-874 ◽  
Author(s):  
J. F. Goubau ◽  
C. K. Goorens ◽  
P. Van Hoonacker ◽  
B. Berghs ◽  
D. Kerckhove ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Survival Rates ◽  
Trapeziometacarpal Joint ◽  
Term Survival ◽  
Numerical Rating ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
The Mean

We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54–78) years. The mean follow-up period was 67 (range 60–77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.

Acute Cervical Radiculopathy Outcomes: Soft Disc Herniations vs Osteophytes

Pain Medicine ◽  
2020 ◽  
Author(s):  
William Jeremy Beckworth ◽  
Benjamin A Abramoff ◽  
Iain M Bailey ◽  
Sook Yoon ◽  
Monica Umpierrez ◽  
...  
Keyword(s):  
Pain Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Pain Scores ◽  
Plain Films ◽  
Numerical Rating ◽  
Disc Herniations

Abstract Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P &gt; 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P &gt; 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P &gt; 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P &gt; 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P &gt; 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes.

scholarly journals Facial Expressions of Pain Among Patients in the Emergency Department

2020 ◽  
Author(s):  
Kuo-Cheng Wang ◽  
Chen-June Seak ◽  
Fu-Sheng Tsai ◽  
Cheng-Yu Chien ◽  
Chi-Chun Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Facial Expressions ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Video Recording ◽  
Self Report ◽  
Receiver Operating Characteristic Curves ◽  
A Value ◽  
Numerical Rating

Abstract Objective: The use of facial expression tracking to measure pain in patients in an emergency clinical setting has not been used before. This study examined facial expressions via an action unit (AU)-based model to determine the pain levels of emergency department (ED) patients.Methods: Adult patients admitted to the ED due to complaints of headache, chest pain, abdominal pain, backache, or painful limbs at triage were included. Two assessments, each lasting at least 30 s, were performed for each participant. A basic description of the pain was acquired, including pain intensity, using a self-report numerical rating scale (NRS). To identify the characteristics of facial expressions of pain, 18 facial AUs were assessed. The model was developed according to analyses of the significantly correlated facial AUs. Area under the receiver operating characteristic curves (AUC) of the AU-based model for different pain severities was calculated.Results: 429 video recording sessions were enrolled for analysis. 57.7% were male and the mean age was 51.3 years. Abdominal pain (49.4%) was the most common complaint, followed by back/limb pain (12.3%). The initial and follow-up mean NRS scores were 6.4 and 3.7, respectively. Several AUs showed significant correlations with NRS scores, including AU 1 (brow raising, p=0.024), AU 4 (brow lowering, p<0.001), and AU 26 (jaw dropping, p=0.038). A model to predict pain severity that included AUs 1, 4, 5, 9, 26, and 45 was created. The AUC of the prediction model to identify severe pain and no pain from others showed a value of 0.633 and 0.645, respectively. Conclusions: Although this study identified several facial AUs correlated with patient self-report NRS pain scores, analysis of facial expressions alone failed to accurately predict pain among patients in the ED. Further studies should aim to develop a more comprehensive means of measuring pain via multiple behavioral measurements.

scholarly journals Role of fasciae in nonspecific low back pain

2019 ◽  
Vol 29 (3) ◽  
Author(s):  
Giulia Casato ◽  
Carla Stecco ◽  
Riccardo Busin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
The Body ◽  
Deep Fascia ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
Patient Reported ◽  
Numerical Rating

More and more evidences show how the thoracolumbar fascia is involved with nonspecific low back pain. Additionally, recent studies about anatomy have shown the presence of a continuity between the thoracolumbar fascia and the deep fascia of the limbs; but actually, a dysfunction of just the thoracolumbar fascia or of the tightly contiguous myofascial tissue is generally recognized as possible cause of nonspecific low back pain. Five patients among those affected by nonspecific low back pain were manipulated just on those fascial spots that were painful, when palpated, and located in other areas of the body than the low back one. Each patient reported a clinically significant reduction of the painful symptoms (a Pain Numerical Rating Scale score difference ≥ 2) straight after the manipulation. A dysfunction of the myofascial tissue that is not tightly contiguous with the symptomatic area is then suggested to be taken into consideration among the causes of nonspecific low back-pain.

scholarly journals POS0438 IS IMAGING DETECTED JOINT INFLAMMATION HELPFUL IN EXPLAINING FATIGUE IN RHEUMATOID ARTHRITIS AT DIAGNOSIS AND DURING THE DISEASE COURSE? – A LARGE MRI STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 448.1-448
Author(s):  
X. Matthijssen ◽  
F. Wouters ◽  
N. Sidhu ◽  
A. van der Helm - van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
Mixed Models ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Joint Inflammation ◽  
Severe Fatigue ◽  
Numerical Rating ◽  
Mri Study ◽  
Subsequent Improvement

Background:Fatigue in rheumatoid arthritis (RA) is hypothesized to be caused by inflammation. Still ~50% of fatigue in RA cannot be explained by the disease activity score (DAS), nor by generic or psychological factors.Objectives:Since MRI can detect joint inflammation more sensitively than DAS, we hypothesized that residual inflammation detected by MRI could aid in explaining fatigue in RA at diagnosis and during follow-up.Methods:526 consecutive RA-patients were followed longitudinally. Fatigue was assessed yearly on a numerical rating scale. Hand and foot MRIs were performed at inclusion, after 12 and 24-months in 199 patients and were scored for inflammation (synovitis, tenosynovitis and osteitis combined). We studied whether RA-patients with more MRI-inflammation were more fatigued at diagnosis (linear regression), whether the 2-year course of MRI-inflammation associated with the course of fatigue (linear mixed models) and whether decrease in MRI-inflammation in year-1 associated with subsequent improvement in fatigue in year-2 (cross-lagged models). Similar analyses were done with DAS as inflammation measure.Results:At diagnosis, higher DAS-scores were associated with more severe fatigue (p<0.001). However, patients with more MRI-inflammation were not more fatigued (p=0.94). During 2-year follow-up, DAS decrease associated with improvement in fatigue (p<0.001), but MRI-inflammation decrease did not (p=0.96). DAS decrease in year-1 associated with fatigue improvement in year-2 (p=0.012), as did MRI-inflammation decrease (p=0.039), with similar effect strength.Conclusion:Sensitive measurements of joint inflammation did not aid in explaining fatigue in RA at diagnosis and follow-up. This supports the concept that fatigue in RA is partly uncoupled from inflammation.Disclosure of Interests:None declared

scholarly journals Introduction of the Novel Radiographic Line (L5-Kyphosis Apex Line) Intended to Evaluate Scheuermann’s Disease and Postural Kyphosis Progression on Standard Lateral X-Rays

2020 ◽  
Vol 14 (3) ◽  
pp. 350-356
Author(s):  
Tomer Bezalel ◽  
Eli Carmeli ◽  
Leonid Kalichman
Keyword(s):  
Body Image ◽  
Thoracic Kyphosis ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Horizontal Distance ◽  
X Rays ◽  
Cross Sectional ◽  
Scheuermann’S Disease ◽  
Scheuermann's Disease

Study Design: Cross-sectional and follow-up nested study.Purpose: To assess the reliability of the L5-kyphosis apex line (L5-KAL) evaluation and determine the association between changes in L5-KAL, changes in radiological parameters, and changes in clinical symptoms.Overview of Literature: Scheuermann’s disease is the most common cause of hyperkyphosis of the thoracolumbar and thoracic spine during adolescence. Scheuermann’s disease patients usually show compensatory hyperlordosis of the lumbar spine, which is usually flexible, and express an anterior translation of the lumbar section. The L5-KAL was developed on the basis of our clinical experience, displaying the horizontal distance between the thoracic and lumbar curves.Methods: In the cross-sectional segment, 150 initial lateral X-rays of patients with Scheuermann’s disease and postural kyphosis were analyzed, and 80 additional X-rays were analyzed in the follow-up segment. The data taken from the X-rays of the whole spinal column included the thoracic kyphosis angle, the C7 plumb line, and the L5-KAL. Clinical data included a numerical rating scale of self-perceived body image, pain, and a Scoliosis Research Society-22 questionnaire (SRS-22).Results: Significant positive associations were observed in a cross-sectional study between the L5-KAL and thoracic kyphosis, lumbar lordosis, C7 line, and self-perceived body image. In the follow-up nested study, in a mixed analysis of variance, the main effect of time was significant for the L5-KAL, kyphotic deformity and SRS-22, which indicated a change in these parameters after treatment of Scheuermann’s disease patients. Significant positive associations were observed between the changes in L5-KAL and the changes in thoracic kyphosis.Conclusions: Our evidence suggests that the L5-KAL can serve as an indicator of the thoracic curve change in Scheuermann’s disease and postural kyphosis patients and should be considered in clinical practice.

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