Neck pain: diagnostic and therapeutic features

Neck pain is a fairly common complaint when visiting a doctor, its occurrence frequency is 10–21% per year, and neck pain takes the 4th place among the causes of disability; almost 50% of patients continue to experience unpleasant sensations or repeated pain episodes. The elderly people are the most prone to the neck pain, this is associated with the progressive degenerative changes in the facet joints and intervertebral discs. However, reasons of this symptom can be of different kinds. Cervicalgia diagnosis is directed primarily to eliminate symptomatic pains associated with severe somatic pathology, immune diseases, infections and oncology. Comorbid diseases and risk factors can combine with each other causing the polyetiologic pain syndrome. Main steps of the cervicalgia diagnostic algorithm are the following: collection of complaints and anamnesis in detail, physical and neurological examination, and also use of visualization methods. Visualization and electrodiagnostic methods are not always informative for patients with chronic cervicalgia and in the degenerative etiology of the syndrome. MRI and the surgeon consultation must be recommended to patients with deteriorating neurological symptoms or with long-term constant pain. Conservative therapy of cervicalgia implies a combination of non-drug methods (compliance with regime, orthopedic treatment, leaf, physiotherapy, etc.) and pharmacotherapy. The last depends on the presence of a neuropathic component of pain and the duration of pain syndrome. The pain therapy with a nociceptive nature is usually implies a combination of non-steroidal anti-inflammatory remedies, non-opioid analgesics and muscle relaxants. Whereas neuropathic pains first-line preparations are tricyclic antidepressants, duloxetine, venlafaxine, pregabalin, gabapentine. The therapy success depends on the proper individual estimation of the pain factors, pain chronization and possible treatment complications. The therapeutic forecast of the acute nonspecific cervicalgia is usually good, but it becomes less predictable if the pain acquires chronic character.

Pediatric Lymphoma Complicated by Intussusception

Intestinal intussusception is rare in children over the age of 6 years and, in most cases, is due to the presence of anatomical reasons. Tumors of the gastrointestinal tract are one of the etiological factors in the development of ileus in older children. The paper presents the case of a 7-year-old child who was admitted to the clinic with the abdominal pain syndrome that resolved on its own. With a repeated pain attack, intestinal intussusception was diagnosed, the patient was urgently operated. Laparoscopic complete reduction of intussusception failed, which required conversion of the access. After straightening the intussusception of the small intestine, there was detected a tumor of the ileum, which practically blocked the intestinal lumen. The segment of the intestine with the tumor was resected with an end-to-end anastomosis. In the postoperative period, the patient was diagnosed with intestinal lymphoma based on the test studies of the operating material. After stabilizing the condition, the child was transferred to an oncological center.

Behavioral Conceptualization and Treatment of Chronic Pain

Pain is considered a hardwired signal of bodily disturbance belonging to a basic motivational system that urges the individual to act and to restore the body's integrity, rather than just a sensory and emotional experience. Given its eminent survival value, pain is a strong motivator for learning. Response to repeated pain increases when harm risks are high (sensitization) and decreases in the absence of such risks (habituation). Discovering relations between pain and other events provides the possibility to predict (Pavlovian conditioning) and control (operant conditioning) harmful events. Avoidance is adaptive in the short term but paradoxically may have detrimental long-term effects. Pain and pain-related responses compete with other demands in the environment. Exposure-based treatments share the aim of facilitating or restoring the pursuit of individual valued life goals in the face of persistent pain, and further improvements in pain treatment may require a paradigm shift toward more personalized approaches.

The Impact of Music on Nociceptive Processing

Objective. Music has been shown to modulate pain, although the impact of music on specific aspects of nociceptive processing is less well understood. Using quantitative sensory testing (QST), we assessed the impact of a novel music app on specific aspects of nociceptive processing. Design. Within-subjects paired comparison of pain processing in control vs music condition. Setting. Human psychophysical laboratory. Subjects. Sixty healthy adult volunteers. Methods. Subjects were assessed for baseline anxiety, depression, and catastrophizing using validated questionnaires. QSTs measured included 1) pain threshold and tolerance to deep muscle pressure, 2) pain with mechanical pinprick, 3) temporal summation of pain (TSP) with a repeated pain stimulus, and 4) conditioned pain modulation (CPM) with a second painful stimulus. QSTs were performed in the absence and presence of music delivered through a music app. Results. We found an increase in pressure pain thresholds in both the forearm (P = 0.007) and trapezius (P = 0.002) with music, as well as a decrease in the amount of pinprick pain (P < 0.001) and TSP (P = 0.01) with music. Interestingly, CPM was also significantly diminished (P < 0.001) in the music condition. No significant difference in cold pain, anxiety, or situational catastrophizing was observed with music. Higher baseline pain catastrophizing scores were associated with less music-induced pressure pain reduction. Conclusions. Several measures of mechanical pain sensitivity were reduced with music. TSP, a measure of central sensitization, also decreased with music, but CPM, a measure of descending modulation of pain, was not further augmented by music.

NURSE COMPLIANCE IN CARRYING OUT PAIN ASSESSMENT IN CANCER PATIENTS [KEPATUHAN PERAWAT DALAM MELAKSANAKAN PENGKAJIAN NYERI PADA PASIEN KANKER]

<p><em>Pain is a frightening thing and symptoms that are very complained of by patients with a diagnosis of cancerIn order to provide nursing care for pain, nurses need to carry out an accurate pain assessment. Pain assessment in one of the hospital is usually conducted by referring to the Standard Operating Procedures </em><em>(SOP). However, nurses do not comply with this SPO so that there is a difference in the data obtained from thquality assurance section of a hospital with reality in the field. The purpose of this study was to determinnurses' compliance in implementing standard operating procedure (SOP) for pain assessment in a privatehospital in Central Indonesia. This research method is quantitative descriptive design. The population of thisstudy were 83 nurses who worked actively in the hospital's chemotherapy room, with a total sample of 30 nurses, taken by purposive sampling technique. The results showed that the level of nurse compliance inconducting pain assessment was as follows: almost most nurses (90%) were in good categories and 67% nurses (20 people) conducted repeated pain assessments in good categories. Nurses play an important role inconducting pain assessment and management in patients therefore the nursing care becomes more effective.Further research can focus on factors that influence nurse compliance in implementing pain assessment in cancer patient.</em></p><p><strong>BAHASA INDONESIA </strong>Nyeri merupakan hal yang menakutkan dan gejala yang sangat dikeluhkan oleh pasien dengan diagnosa kanker. Agar dapat memberikan asuhan keperawatan terhadap nyeri, perawat perlu melakukan pengkajian nyeri yang akurat. Pengkajian nyeri di salah satu rumah sakit biasanya dilakukan dengan mengacu pada Standar Prosedur Operasional (SPO). Namun seringkali perawat tidak mematuhi SPO ini sehingga terjadi perbedaan data yang diperoleh dari bagian penjaminan mutu suatu rumah sakit dengan kenyataan di lapangan. Tujuan penelitian ini adalah mengetahui kepatuhan perawat dalam melaksanakan SPO pengkajian nyeri di sebuah rumah sakit swasta di Indonesia Bagian Tengah. Metode penelitian ini adalah desain deskriptif kuantitatif. Populasi penelitian ini adalah 83 perawat yang bekerja aktif di ruang kemoterapi rumah sakit tersebut, dengan jumlah sampel 30 perawat, yang diambil dengan teknik purposive sampling. Hasil penelitian menunjukkan bahwa tingkat kepatuhan perawat dalam melakukan pengkajian nyeri sebagai berikut: hampir sebagian besar perawat (90%) berada dalam kategori baik dan 67% perawat (20 orang) melakukan pengkajian nyeri secara berulang berada dalam kategori baik. Perawat memegang peranan yang penting dalam melakukan pengkajian dan manajemen nyeri pada pasien agar asuhan menjadi efektif. Penelitian selanjutnya dapat berfokus pada faktor – faktor yang memengaruhi kepatuhan perawat dalam melaksanakan pengkajian nyeri pada pasien kanker.</p>

Exosomes May Be the Potential New Direction of Research in Osteoarthritis Management

Osteoarthritis (OA) is a joint degenerative disease, which is prominent in the middle-aged and elderly population, often leading to repeated pain in the joints of patients and seriously affecting the life quality of patients. At present, the treatment of OA mainly depends on the surgery and drug treatment. Nevertheless, these treatments still face many problems, such as surgical safety, complications, and drug side effects. Exosomes can be secreted and released by multiple cell types and have lipid bilayer membranes and contain abundant biological molecules, including proteins, lipids, and nucleic acids. Moreover, exosomes play a critical role in local and distal intercellular and intracellular communication. In recent years, several studies have found that exosomes can regulate the progression of OA and have a potential efficacy for OA treatment. Thus, in this article, we summarize and review the relevant research of exosomes in OA and emphasize the importance of exosomes in the development of OA.

Effectiveness of Music Therapy for Alleviating Pain During Shunt Punctures for Patients Undergoing Haemodialysis: A Multi-facility, Single-blind, Randomised Controlled Trial

Background Repeated pain during shunt vessel punctures is a serious problem for haemodialysis patients, even when prescribed external analgesics. While some studies have observed the efficacy of music therapy for improving pain and anxiety, its effectiveness during vessel punctures during dialysis is uncertain. The purpose of this study is to investigate the effects of music therapy for pain when cannulating a shunt blood vessel for haemodialysis patients. Methods A prospective, multi-facility, single-blind, crossover, randomised controlled trial will be implemented. The intervention includes listening to Mozart, along with a white noise control condition. One hundred twenty haemodialysis patients will be enrolled across five facilities. Patients will be randomly allocated to either an Early-sequence group or a Later-sequence group. The Early-sequence group will receive puncture while listening to Mozart’s Sonata for 2 pianos in D major (K.448) during the second week (Music period) and white noise during the fourth week (White noise period). The Later-sequence group will receive puncture along with white noise first, followed by Mozart. All patients will also undergo puncture during a ‘no-sound period (only wearing headphones) during the first and third week (No-sound period). The music or no-music protocol will begin 8 minutes prior to the puncturing procedure, and participants will finish listening after starting haemodialysis during each period. The primary outcomes that will be assessed include the Visual Analogue Scale (VAS) score for pain during puncture, and secondary outcomes such as blood pressure, heart rate, VAS anxiety score, State-Trait Anxiety Inventory score, and salivary amylase activity. The operator will be blind to each listening condition and VAS report. Discussion The proposed study has several methodological benefits. First, using white noise is a suitable control condition for addressing the role of sound on pain management. Additionally, using a crossover design with repeated measurements can help control individual differences between participants, which should better distinguish between- and within-participant variability. Overall, music therapy is a safe and inexpensive intervention that does not have the problematic side effects typically associated with pharmacological treatment. If effective, music therapy can be easily implemented for reducing pain and anxiety during cannulation.

Use of expressed breast milk for pain relief during venepuncture in neonates

Background: It is now known that repeated pain in neonatal period influences neurodevelopmental outcome. It is necessary to assess and manage neonatal pain with appropriate interventions. The objective is to study whether expressed breast milk effectively reduces neonatal pain after venepuncture in comparison to placebo using sterile water.Methods: In this randomised controlled trial, neonates were randomised into two groups-expressed breast milk group and placebo group with 40 neonates in each group. Two minutes before venepuncture, 2 ml of test solution was administered. Mean Premature Infant Pain Profile (PIPP) score and mean cry time were recorded in neonates of both groups after venepuncture and compared.Results: At 0-30 second, 1-1 ½ minute, 3-3 ½ minute, 5-5 ½ minute after venepuncture, neonates in placebo group had mean PIPP score of 11.475, 10.125, 9.125, 7.575 respectively. At the same time intervals, mean PIPP score was 9.375, 7.825, 6.475, 5.05 in neonates of expressed breast milk group. Mean cry time after venepuncture was 105.65 seconds and 75.825 seconds in the placebo group and expressed breast milk group respectively.Conclusions: Compared to placebo, expressed breast milk significantly reduced mean PIPP score and cry time in neonates.