Browsing by Subject "Pain"

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  • Marttinen, Maiju K.; Kautiainen, Hannu; Haanpää, Maija; Pohjankoski, Heini; Hintikka, Jukka; Kauppi, Markku J. (2021)
    Background: Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults' prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods: One thousand four hundred twenty community-dwelling citizens aged 62-86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results: Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion: Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults' pain management.
  • Marttinen, Maiju K; Kautiainen, Hannu; Haanpää, Maija; Pohjankoski, Heini; Hintikka, Jukka; Kauppi, Markku J (BioMed Central, 2021)
    Abstract Background Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.
  • Karjalainen, M.; Saltevo, J.; Tiihonen, M.; Haanpää, M.; Kautiainen, H.; Mäntyselkä, P. (2018)
    Background: The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care. Methods: All home-dwelling persons 65 years or older with diabetes (N = 527) and age and gender matched controls (N = 890) were identified from electronic patient records. Frequent pain was regarded as any pain experienced more often than once a week, and it was divided into pain experienced several times a week but not daily and pain experienced daily or continuously. The Numeric Rating Scale (0-10) (NRS) was used to assess the intensity and interference of the pain. Results: The number of subjects who returned the questionnaire was 1084 (76.5%). The prevalence of frequent pain in the preceding week was 50% among women without diabetes and 63% among women with diabetes (adjusted, p = 0.22). In men, the corresponding proportions were 42% without diabetes and 47% with diabetes (adjusted, p = 0.58). In both genders, depressive symptoms and the number of comorbidities were associated with pain experienced more often than once a week and with daily pain. Diabetes was not associated with pain intensity or pain interference in either women or men. Conclusions: Pain in older adults is associated with depressive symptoms and the number of comorbidities more than with diabetes itself.
  • Åström, Max J.; von Bonsdorff, Mikaela B.; Haanpää, Maija; Salonen, Minna K.; Kautiainen, Hannu; Eriksson, Johan G. (2021)
    Aims: To assess if individuals with diabetes or prediabetes report more pain or have increased use of pain medication compared to normoglycaemic individuals. Methods: Using cross-sectional data, we studied 928 men and 1075 women from the Helsinki Birth Cohort Study in 2001-2004 at a mean age of 61.5 years. Glucose regulation was assessed with a 2-h 75 g oral glucose tolerance test, and applying World Health Organization criteria, participants were defined as having normoglycaemia, prediabetes (impaired fasting glucose or impaired glucose tolerance), newly diagnosed diabetes or previously diagnosed diabetes. Self-reported pain intensity and interference during the previous 4 weeks was estimated using the RAND 36-Item Health Survey 1.0. Information on use of pain medication during the past 12 months was obtained from the Social Insurance Institution of Finland. Results: There was no difference in pain intensity or interference between glucose regulation groups for neither men nor women after adjusting for covariates (age, body mass index, education years, Beck Depression Inventory and physical activity). In addition, use of pain medication was similar between glucose regulation groups. Conclusions: Although pain is a common symptom in the general population, impairments in glucose regulation alone does not seem to increase pain among older individuals. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
  • Söderlund, Tim; Reitala, Janne (2021)
    Kylkiluiden sarjamurtuman yhteydessä potilaan hallitseva oire on mobilisoitumiseen, hengittämiseen ja yskimiseen liittyvä kipu rintakehän alueella. Vammaan saattaa liittyä rintakehän segmentaalinen instabiilius (varsta- eli hetkurinta) (VIDEO). Muita mahdollisia liitännäisvammoja ovat keuhkoruhje sekä veri- ja ilmarinta. Suurienergiaisissa vammoissa vartalon varjoainetehosteinen tietokonetomografia (TT) on aina ensisijainen tutkimus. Pienienergiaisten vammojen osalta riittää usein keuhkokuva, joka otetaan potilaan seisoessa. Kivun aktiivinen hoito, varhainen mobilisaatio ja tarvittaessa hengityksen kajoamaton tukeminen ovat avainasemassa hengitysvajauksen estämisessä. Hengitysvajauksen riskin ennustamista vaikeuttaa se, että kipu on pahimmillaan vasta vammaa seuraavina päivinä. Useimmiten sarjamurtumapotilas kuuluu tehostettuun valvontaan, kunnes hengitysvajauksen vaara on ohi. Kirurginen hoito on tehokas pienelle potilasjoukolle. Esittelemme Töölön sairaalan hoitokäytännön.
  • Sipilä, Reetta; Kalso, Eija; Lötsch, Jörn (2020)
    Background: Persistent pain in breast cancer survivors is common. Psychological and sleep-related factors modulate perception, interpretation and coping with pain and may contribute to the clinical phenotype. The present analysis pursued the hypothesis that breast cancer survivors form subgroups, based on psychological and sleep-related parameters that are relevant to the impact of pain on the patients' life. Methods: We analysed 337 women treated for breast cancer, in whom psychological and sleep-related parameters as well as parameters related to pain intensity and interference had been acquired. Data were analysed by using supervised and unsupervised machine-learning techniques (i) to detect patient subgroups based on the pattern of psychological or sleep-related parameters, (ii) to interpret the detected cluster structure and (iii) to relate this data structure to pain interference and impact on life. Results: Artificial intelligence-based detection of data structure, implemented as self-organizing neuronal maps, identified two different clusters of patients. A smaller cluster (11.5% of the patients) had comparatively lower resilience, more depressive symptoms and lower extraversion than the other patients. In these patients, life-satisfaction, mood, and life in general were comparatively more impeded by persistent pain. Conclusions: The results support the initial hypothesis that psychological and sleep-related parameter patterns are meaningful for subgrouping patients with respect to how persistent pain after breast cancer treatments interferes with their life. This indicates that management of pain should address more complex features than just pain intensity. Artificial intelligence is a useful tool in the identification of subgroups of patients based on psychological factors. (C) 2020 The Authors. Published by Elsevier Ltd.
  • Loetsch, Joern; Sipilä, Reetta; Tasmuth, Tiina; Kringel, Dario; Estlander, Ann-Mari; Meretoja, Tuomo; Kalso, Eija; Ultsch, Alfred (2018)
    Background Prevention of persistent pain following breast cancer surgery, via early identification of patients at high risk, is a clinical need. Supervised machine-learning was used to identify parameters that predict persistence of significant pain. Methods Over 500 demographic, clinical and psychological parameters were acquired up to 6 months after surgery from 1,000 women (aged 28-75 years) who were treated for breast cancer. Pain was assessed using an 11-point numerical rating scale before surgery and at months 1, 6, 12, 24, and 36. The ratings at months 12, 24, and 36 were used to allocate patents to either "persisting pain" or "non-persisting pain" groups. Unsupervised machine learning was applied to map the parameters to these diagnoses. Results A symbolic rule-based classifier tool was created that comprised 21 single or aggregated parameters, including demographic features, psychological and pain-related parameters, forming a questionnaire with "yes/no" items (decision rules). If at least 10 of the 21 rules applied, persisting pain was predicted at a cross-validated accuracy of 86% and a negative predictive value of approximately 95%. Conclusions The present machine-learned analysis showed that, even with a large set of parameters acquired from a large cohort, early identification of these patients is only partly successful. This indicates that more parameters are needed for accurate prediction of persisting pain. However, with the current parameters it is possible, with a certainty of almost 95%, to exclude the possibility of persistent pain developing in a woman being treated for breast cancer.
  • Kaukinen, P.; Podlipska, J.; Guermazi, A.; Niinimaki, J.; Lehenkari, P.; Roemer, F. W.; Nieminen, M. T.; Koski, J. M.; Saarakkala, S.; Arokoski, J. P. A. (2017)
    Objective: The main aim was to investigate the associations between Magnetic Resonance Imaging (MRI)-defined structural pathologies of the knee and physical function. Design: A cohort study with frequency matching on age and sex with eighty symptomatic subjects with knee pain and suspicion or diagnosis of knee osteoarthritis (OA) and 57 asymptomatic subjects was conducted. The subjects underwent knee MRI, and the severity of structural changes was graded by MRI Osteoarthritis Knee Score (MOAKS) in separate knee locations. WOMAC function subscores were recorded and physical function tests (20-m and 5-min walk, stair ascending and descending, timed up & go and repeated sit-to-stand tests) performed. The association between MRI-defined structural pathologies and physical function tests and WOMAC function subscores were evaluated by linear regression analysis with adjustment for demographic factors, other MRI-features and pain with using effect size (ES) as a measure of the magnitude of an association. Results: Cartilage degeneration showed significant association with poor physical performance in TUG-, stair ascending and descending-, 20-m- and 5-min walk-tests (ESs in the subjects with cartilage degeneration anywhere between 0.134 [95%CI 0.037-0.238] and 0.224 [0.013-0.335]) and with increased WOMAC function subscore (ES in the subjects with cartilage degeneration anywhere 0.088 [0.012-0.103]). Also, lateral meniscus maceration and extrusion were associated with poor performance in stair ascending test (ESs 0.067 [0.008-0.163] and 0.077 [0.012-0.177]). Conclusions: After adjustments cartilage degeneration was associated with both decreased self-reported physical function and poor performance in the physical function tests. Furthermore, subjects with lateral meniscus maceration and extrusions showed significantly worse performance in stair ascending tests. (C) 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
  • Lindahl, Jan (2019)
  • Kanto, Kari; Lähdeoja, Tuomas; Paavola, Mika; Aronen, Pasi; Järvinen, Teppo L. N.; Jokihaara, Jarkko; Ardern, Clare L.; Karjalainen, Teemu V.; Taimela, Simo (BioMed Central, 2021)
    Abstract Background The results of clinical trials should be assessed for both statistical significance and importance of observed effects to patients. Minimal important difference (MID) is a threshold denoting a difference that is important to patients. Patient acceptable symptom state (PASS) is a threshold above which patients feel well. Objective To determine MID and PASS for common outcome instruments in patients with subacromial pain syndrome (SAPS). Methods We used data from the FIMPACT trial, a randomised controlled trial of treatment for SAPS that included 193 patients. The outcomes were shoulder pain at rest and on arm activity, both measured with the 0–100 mm visual analogue scale (VAS), the Constant-Murley score (CS), and the Simple Shoulder Test (SST). The transition question was a five-point global rating of change. We used three anchor-based methods to determine the MID for improvement: the receiver operating characteristic (ROC) curve, the mean difference of change and the mean change methods. For the PASS, we used the ROC and 75th percentile methods and calculated estimates using two different anchor question thresholds. Results Different MID methods yielded different estimates. The ROC method yielded the smallest estimates for MID: 20 mm for shoulder pain on arm activity, 10 points for CS and 1.5 points for SST, with good to excellent discrimination (areas under curve (AUCs) from 0.86 to 0.94). We could not establish a reliable MID for pain at rest. The PASS estimates were consistent between methods. The ROC method PASS thresholds using a conservative anchor question threshold were 2 mm for pain at rest, 9 mm for pain on activity, 80 points for CS and 11 points for SST, with AUCs from 0.74 to 0.83. Conclusion We recommend the smallest estimate from different methods as the MID, because it is very unlikely that changes smaller than the smallest MID estimate are important to patients: 20 mm for pain VAS on arm activity, 10 points for CS and 1.5 points for SST. We recommend PASS estimates of 9 mm for pain on arm activity, 80 points for CS, and 11 points for SST. Trial registration ClinicalTrials.gov NCT00428870 (first registered January 29, 2007).
  • Isokuortti, Harri; Luoto, Teemu (2019)
    Tavallisin syy aivovammaan on kaatuminen ja suurin osa vammoista on lieviä. Alkuvaiheessa tärkeintä on sulkea pois vakavan vamman mahdollisuus. Tapahtumatiedot, löydökset ja oireet kirjataan huolellisesti. Olennaisia ovat tajunnan muutokset, muistiaukko ja kuvantamislöydökset. Akuuttivaiheessa ensisijainen kuvantamismuoto on pään tietokonetomografia. Sillä voidaan sulkea pois vakavat kallonsisäiset verenvuodot. Toipumista voidaan edistää oireenmukaisella hoidolla ja potilasohjauksella. Ennuste on hyvä, mutta toipumisen pitkittyessä erikoissairaanhoidon arvio on usein tarpeen.
  • Vironen, Jaana (2017)
    Tyrien kirurginen hoito tähtää ensisijaisesti elämänlaadun parantamiseen, joten oireetonta tyrää ei aina kannata leikata. Kureutumisriski ja ihon venymiseen liittyvät ongelmat saattavat joskus olla leikkaushoidon aihe. Krooniset kipuoireet ovat kohtalaisen yleisiä ongelmia tyräleikkauksen jälkeen. Diagnostiikassa ei yleensä tarvita kuvantamistutkimuksia. Kliininen kuva ja tieto potilaan oireista riittävät lähetetiedoksi.
  • Kemppainen, Venla; Mentula, Maarit; Palkama, Vilja; Heikinheimo, Oskari (2022)
    Objective: To compare oxycodone administration via intravenous patient-controlled analgesia (IVPCA) vs on-demand administration during late-first- and second-trimester medically induced abortion. Study design: A prospective randomized controlled study. We enrolled women between 64 to 128 days of gestation in the study between June 2016 and August 2018. Participants were randomized to receive oxycodone either via IVPCA or given on-demand orally, intramuscularly, or intravenously. Pain intensity and satisfaction with care were measured using the visual analogue scale (VAS, 0–100mm). Results: Altogether 99 participants were randomized: 48 in IVPCA group and 51 in on-demand group. Median gestational age was similar between groups (74 days [Interquartile range, IQR 69–81] in the IVPCA group vs 72 [69–80] in the control group, p = 0.587). Peak maximal pain was severe in both groups (median pain VAS was 62 [IQR 44–84] and 71 [IQR 56–90], p = 0.52). The odds for severe pain (highest pain VAS≥70) were similar between the groups (IVPCA group OR 0.51 [95% Confidence Interval 0.22–1.18], p = 0.118). In contrast, the odds for mild or tolerable pain (highest pain VAS≤40) were higher in the IVPCA group (OR 4.06 [95% CI 1.05–16.04], p = 0.043). Nevertheless, satisfaction with care was high (VAS 94 [89–100]) in both groups. Of those experiencing severe pain, 94.0% declared pain medication as adequate. Conclusion: Women often experience severe pain during medical abortion irrespective of the mode of opiate administration. Oxycodone administration via IVPCA permits women to self-administer analgesics when experiencing pain, raising the odds for mild or tolerable pain during abortion care. Satisfaction with care was high.
  • Lapatto, Risto (2020)
  • Coccolini, Federico; Corradi, Francesco; Sartelli, Massimo; Coimbra, Raul; Kryvoruchko, Igor A.; Leppaniemi, Ari; Doklestic, Krstina; Bignami, Elena; Biancofiore, Giandomenico; Bala, Miklosh; Marco, Ceresoli; Damaskos, Dimitris; Biffl, Walt L.; Fugazzola, Paola; Santonastaso, Domenico; Agnoletti, Vanni; Sbarbaro, Catia; Nacoti, Mirco; Hardcastle, Timothy C.; Mariani, Diego; De Simone, Belinda; Tolonen, Matti; Ball, Chad; Podda, Mauro; Di Carlo, Isidoro; Di Saverio, Salomone; Navsaria, Pradeep; Bonavina, Luigi; Abu-Zidan, Fikri; Soreide, Kjetil; Fraga, Gustavo P.; Carvalho, Vanessa Henriques; Batista, Sergio Faria; Hecker, Andreas; Cucchetti, Alessandro; Ercolani, Giorgio; Tartaglia, Dario; Galante, Joseph M.; Wani, Imtiaz; Kurihara, Hayato; Tan, Edward; Litvin, Andrey; Melotti, Rita Maria; Sganga, Gabriele; Zoro, Tamara; Isirdi, Alessandro; De'Angelis, Nicola; Weber, Dieter G.; Hodonou, Adrien M.; TenBroek, Richard; Parini, Dario; Khan, Jim; Sbrana, Giovanni; Coniglio, Carlo; Giarratano, Antonino; Gratarola, Angelo; Zaghi, Claudia; Romeo, Oreste; Kelly, Michael; Forfori, Francesco; Chiarugi, Massimo; Moore, Ernest E.; Catena, Fausto; Malbrain, Manu L. N. G. (2022)
    Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.