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- Göransson, Katarina, 1974-, et al.
(författare)
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Pain rating in the ED—a comparison between 2 scales in a Swedish hospital
- 2015
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Ingår i: American Journal of Emergency Medicine. - : Elsevier Inc. - 0735-6757 .- 1532-8171. ; 33:3, s. 419-422
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background Pain is common at an emergency department (ED). Two common scales used to rate intensity are the visual analog scale (VAS) and the numeric rating scale (NRS), but it remains unknown which is superior to use in the ED. Aim The aim of the study is to compare correlations between values on the VAS and the NRS in patients visiting the ED as well as to assess the patients' preference of scale. Methods Patients who visited the ED due to chest pain, abdominal pain, or an orthopedic condition during autumn 2012 were enrolled onto a cross-sectional study with a consecutive sample. Patients rated their pain using the VAS and NRS scales. They answered an open-ended oral questionnaire regarding their preference and their estimation of the sufficiency of the scales. Data were analyzed with significance test. Results In all, 217 patients (70% of eligible, 94% of invited) participated. The pain scores generated from the NRS and the VAS were found to strongly correlate (mean difference, 0.41; 95% confidence interval, 0.29-0.53). Most patients found the NRS easier to use than the VAS (61% and 22%, respectively; P < .001). Furthermore, a majority reported that the NRS reflected/described their pain better than the VAS (53% and 26%, respectively; P < .01). Conclusion Because values on the NRS correspond well to values on the VAS, values rated with different scales over time might be comparable. Because a majority of the patients found the NRS scale simpler to use and preferred it over the VAS, it might be more appropriate to use in the ED.
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| 3. |
- Heilborn, Umut
(författare)
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Behavioural and neurochemical effects of long-lasting inflammatory pain
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The treatment of chronic, inflammatory pain in humans is still unsatisfactory. In order to develop new anti-inflammatory and analgesic drugs, studies on the mechanisms underlying inflammatory pain in valid animal models, are of considerable importance. In the present thesis, we have investigated behavioural and neurochemical alterations in animal models of long lasting inflammatory pain. We have also addressed this field from a methodological perspective. In addition, we have investigated a pharmacological approach in animals which has been suggested to prevent the generation of chronic pain in humans. Treatment with morphine prior to surgical interventions has been suggested to prevent the development of subsequent pain conditions. However, previous animal and human studies have shown contradictory results. We therefore examined the antinociceptive effect of morphine given before or after the induction of monoarthritis in rats. In order to investigate a possible correlation to the behavioural response, the plasma concentrations of morphine were followed. In the present preclinical setting, our data do not support an advantageous effect of administration of morphine prior to the induction of arthritis compared to morphine treatment after the onset of inflammatory pain. The development of transgenic techniques has accentuated the need for valid disease models in mice. We therefore developed a model for joint inflammation in mice: adjuvant-induced monoarthritis. We estimated pain-related behaviour by scoring of gait and stance and we validated the model pharmacologically by administrating two different analgesic drugs, morphine and the non-steroid anti-inflammatory drug (NSAID) diclofenac. We conclude that adjuvant-induced monoarthritis, which has a limited effect on the general state of health of the animals compared to polyarthritic models, constitutes a robust and reproducible model in mice. This model is likely to be useful in patophysiological and pharmacological studies on inflammatory pain in transgenic mice. However, the choice of mouse strain is of importance for the results obtained. Several human and animal studies indicate that the anterior cingulate cortex (ACC) plays an important role in the affective component of pain. The neuropeptide cholecystokinin (CCK) has been suggested to be involved in anxiety and in the modulation the antinociceptive effects of opioids in the spinal cord and medulla oblongata. However, its possible role in pain transmission or modulation in the brain is far less clear. CCK is particularly abundant in the ACC and we hypothesised that CCK in this brain region may play a role in pain, possibly in the affective component. Using a model for subchronic inflammatory joint pain in rats, we studied the effect of pain on the release of CCK in the ACC. We found that animals with inflammatory pain had a significantly increased release of CCK in the ACC compared to controls. We then proceeded by investigating whether the increased CCK release could be affected by morphine and diclofenac. Morphine, unlike diclofenac, is known to relieve the affective component of pain. Surprisingly, we found that diclofenac but not morphine reduced the increased CCK release in the ACC of rats with inflammatory pain. Thus, our results argue against the hypothesis that CCK in the ACC is involved in the affective component of pain, but rather indicates that the observed increase in CCK could be mediated by an elevation in prostaglandin levels. Further studies on the interaction between prostaglandins and CCK in the brain may provide a future basis for the treatment of inflammatory pain in humans.
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| 4. |
- Pettersson, Anna, et al.
(författare)
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Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation.
- 2018
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Ingår i: Critical Pathways in Cardiology. - 1535-282X .- 1535-2811. ; 17:1, s. 6-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome.Methods: All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death.Results: A total of 1091 patients were included. Dynamic 1-hour changes in hs-cTnT defined as an increase or decrease of ≥3 ng/L occurred in 23 patients (2.1%). Fifteen patients (65.2%) in the dynamic group were admitted, compared with 148 patients (13.9%) in the nondynamic group (P < 0.001). Four of the admitted patients (26.7%) in the dynamic and 1 (0.7%) in the nondynamic group were diagnosed with an MI (P < 0.001). No death or MI occurred within 30 days among those discharged from the ED.Conclusions: Dynamic 1-hour changes in hs-cTnT were uncommon but associated with a higher rate of admission and of MI in an unselected population of chest pain patients with a nonelevated hs-cTnT at presentation. Lack of dynamic changes makes MI highly unlikely, and a 1-hour measurement may facilitate an early rule out of MI but should be used together with clinical assessment.
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