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Trajectory of Postoperative Wound Pain Within the First 2 Weeks Following Posterior Spinal Fusion Surgery in Adolescent Idiopathic Scoliosis Patients

Kwan MK, Chiu CK, Chan TS, Chong KI, Mohamad SM, Hasan MS, et al.

Spine (Phila Pa 1976), 2017 Jun 01;42(11):838-843.
PMID: 28538525 DOI: 10.1097/BRS.0000000000001902

STUDY DESIGN: A prospective cohort study.
OBJECTIVE: The aim of this study was to determine and evaluate the trajectory of surgical wound pain from day 1 to day 14 after posterior spinal fusion (PSF) surgery in patients with adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA: Information regarding how the postoperative pain improves with time offers invaluable information not only to the patients and parents but also to assist the clinician in managing postoperative pain.
METHODS: AIS patients who were planned for elective PSF surgery from September 2015 to December 2015 were prospectively recruited into this study. All patients underwent a similar pain management regimen with patient-controlled anesthesia (PCA) morphine, acetaminophen, celecoxib, and oxycodone hydrochloride.
RESULTS: A total of 40 patients (36 F:4 M) were recruited. The visual analogue score (VAS) pain score was highest at 12 hours postoperation (6.0 ± 2.3). It reduced to 3.9 ± 2.2 (day 4), 1.9 ± 1.6 (day 7), and 0.7 ± 1.1 (day 14). The total PCA usage in all patients was 12.4 ± 9.9 mg (first 12 hours), 7.1 ± 8.0 mg (12 to 24 hours), 5.6 ± 6.9 (24-36 hours), and 2.1 ± 6.1 mg (36-48 hours). The celecoxib capsules usage was reducing from 215.0 ± 152.8 mg at 24 hours to 55.0 ± 90.4 mg on day 14. The acetaminophen usage was reducing from 2275 ± 1198 mg at 24 hours to 150 ± 483 mg at day 14. Oxycodone hydrochloride capsules consumption rose to the peak of 1.4 ± 2.8 mg on day 4 before gradually reducing to none by day 13.
CONCLUSION: With an adequate postoperation pain regimen, significant pain should subside to a tolerable level by postoperative day 4 and negligible by postoperative day 7. Patient usually can be discharged on postoperative day 4 when the usage of PCA morphine was not required.
LEVEL OF EVIDENCE: 2.

Matched MeSH terms: Pain Measurement
Fulltext Prevalence of nontraumatic foot pain among urban young working women and its contributing factors

Chua YP, Tan WJ, Yahya TS, Saw A

Singapore Med J, 2013 Nov;54(11):630-3.
PMID: 24276099

INTRODUCTION: Foot pain is a common problem, especially in women, and studies have shown that it is related to footwear. This study was conducted to establish the prevalence of nontraumatic foot pain and its contributing factors in young working Malaysian women in an urban setting.

METHODS: The survey was conducted on a group of working women (age range 21-40 years) selected using convenience sampling. Data on foot problems was collected through an investigator-directed questionnaire and during clinical inspection of the foot.

RESULTS: A total of 400 women, with a mean age of 29.4 years, were recruited. Half (n = 200) of the women had experienced recurrent nontraumatic foot pain in the past one year. Subjective assessments of foot pain using the Numeric Intensity Scale gave an average score of 4.89 ± 1.78 (range 2-10), with most episodes occurring at the heel. There was no statistically significant association between foot pain and age, ethnicity or body mass index. However, there was a higher incidence of foot pain in women wearing high-heeled footwear than those wearing non-high-heeled footwear (p = 0.027, odds ratio 1.591).

CONCLUSION: Nontraumatic foot pain is common among young working women in our society. More than half (68.4%) of the women with foot pain in our study attributed the pain to footwear. Wearing high-heeled shoes to work was a significant contributing factor. Increased public awareness on the importance of proper footwear may help to reduce the prevalence of nontraumatic foot pain in working women.

Matched MeSH terms: Pain Measurement
Fulltext Venipuncture versus heel prick for blood glucose monitoring in neonates

Saththasivam P, Umadevan D, Ramli N, Voralu K, Naing NN, Ilias MI, et al.

Singapore Med J, 2009 Oct;50(10):1004-7.
PMID: 19907892

The aim of this study was to determine whether there was a difference in the pain indicators and effectiveness between venipuncture (VP) and heel prick (HP) for blood glucose monitoring in term neonates (recently, venipuncture was shown superior for the Guthrie test).

Matched MeSH terms: Pain Measurement
Fulltext An open-label randomised controlled trial on the efficacy of adding intranasal fentanyl to intravenous tramadol in patients with moderate to severe pain following acute musculoskeletal injuries

Chew KS, Shaharudin AH

Singapore Med J, 2017 Oct;58(10):601-605.
PMID: 27193080 DOI: 10.11622/smedj.2016096

INTRODUCTION: The use of intranasal fentanyl as an alternative type of analgesia has been shown to be effective in paediatric populations and prehospital settings. There are a limited number of studies on the use of intranasal fentanyl in adult patients in emergency settings.
METHODS: An open-label study was conducted to evaluate the effectiveness of the addition of 1.5 mcg/kg intranasal fentanyl to 2 mg/kg intravenous tramadol (fentanyl + tramadol arm, n = 10) as compared to the administration of 2 mg/kg intravenous tramadol alone (tramadol-only arm, n = 10) in adult patients with moderate to severe pain due to acute musculoskeletal injuries.
RESULTS: When analysed using the independent t-test, the difference between the mean visual analogue scale scores pre-intervention and ten minutes post-intervention was 29.8 ± 8.4 mm in the fentanyl + tramadol arm and 19.6 ± 9.7 mm in the tramadol-only arm (t[18] = 2.515, p = 0.022, 95% confidence interval 1.68-18.72 mm). A statistically significant, albeit transient, reduction in the ten-minute post-intervention mean arterial pressure was noted in the fentanyl + tramadol arm as compared to the tramadol-only arm (13.35 mmHg vs. 7.65 mmHg; using Mann-Whitney U test with U-value 21.5, p = 0.029, r = 0.48). There was a higher incidence of transient dizziness ten minutes after intervention among the patients in the fentanyl + tramadol arm.
CONCLUSION: Although effective, intranasal fentanyl may not be appropriate for routine use in adult patients, as it could result in a significant reduction in blood pressure.

Matched MeSH terms: Pain Measurement
Fulltext The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial

Chiu CK, Low TH, Tey YS, Singh VA, Shong HK

Singapore Med J, 2011 Dec;52(12):868-73.
PMID: 22159928

INTRODUCTION: Chronic, nonspecific low back pain is a difficult ailment to treat and poses an economic burden in terms of medical expenses and productivity loss. The aim of this study was to determine the efficacy and safety of intramuscular metylcobalamin in the treatment of chronic nonspecific low back pain.
METHODS: This was a double-blinded, randomised, controlled experimental study. 60 patients were assigned to either the methylcobalamin group or the placebo group. The former received intramuscular injections of 500 mcg parenteral methylcobalamin in 1 ml solution three times a week for two weeks, and the placebo group received 1 ml normal saline. Patients were assessed with Oswestry Disability Index questionnaire Version 2.0 and Visual Analogue Scale pain score. They were scored before commencement of the injections and at two months interval.
RESULTS: Of the 60 patients, 27 received the placebo injections and 33 were given methylcobalamin injections. A total of 58 patients were available for review at two months (placebo: n is 26; methylcobalamin: n is 32). There was a significant improvement in the Oswestry Disability Index and Visual Analogue Scale pain scores in the methylcobalamin group as compared with the placebo group (p-value less than 0.05). Only minor adverse reactions such as pain and haematoma at the injection sites were reported by some patients.
CONCLUSION: Intramuscular methylcobalamin is both an effective and safe method of treatment for patients with nonspecific low back pain, both singly or in combination with other forms of treatment.
Study site: Orthopaedic Clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Pain Measurement
Fulltext Efficacy and tolerability of celecoxib compared with diclofenac slow release in the treatment of acute ankle sprain in an Asian population

Nadarajah A, Abrahan L, Lau FL, Hwang LJ, Fakir-Bolte C

Singapore Med J, 2006 Jun;47(6):534-42.
PMID: 16752024

INTRODUCTION: Cyclooxygenase (COX)-2 selective inhibitors are attractive candidates for treatment of ankle sprain because of their efficacy as anti-inflammatory and analgesic agents and their overall safety, including lack of effect on platelet aggregation. The objective of this study was to assess the efficacy and tolerability of celecoxib compared with diclofenac slow release (SR) in the treatment of acute ankle sprain in an Asian population.
METHODS: In this seven-day, multicentre, double-blind, randomised, parallel-group trial, 370 patients with first- or second-degree ankle sprain occurring at or less than 48 hours prior to the first dose of study medication were randomised to receive celecoxib 200 mg bid (189 patients) after a 400 mg loading dose or diclofenac SR 75 mg bid (181 patients). Patients were required to demonstrate moderate to severe ankle pain on weight bearing (45 mm or greater on a 100 mm visual analogue scale [VAS]) at baseline. The primary efficacy end point was the patient's assessment of ankle pain (VAS on full weight bearing) on day 4.
RESULTS: Celecoxib was as effective as diclofenac SR in improving the signs and symptoms of ankle sprain. At day 4, mean VAS scores for celecoxib and diclofenac SR had decreased to 28 mm and 30 mm, respectively. Treatment differences were not statistically significant. Incidence of upper gastrointestinal adverse events was low in both treatment groups (0.5 percent versus 2.2 percent for celecoxib and diclofenac SR, respectively).
CONCLUSION: Celecoxib, a COX-2 selective inhibitor, is as effective as diclofenac SR in treating ankle sprains. With its platelet-sparing properties, celecoxib may offer an advantage over diclofenac SR in managing musculoskeletal injuries.

Matched MeSH terms: Pain Measurement
Fulltext Survey of postoperative pain in University Hospital Kuala Lumpur

Vijayan R, Tay KH, Tan LB, Loganathan

Singapore Med J, 1994 Oct;35(5):502-4.
PMID: 7701371

One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.

Matched MeSH terms: Pain Measurement
Incidence of pain after biomechanical preparation: a review of 302 cases treated by dental students

Mohd Sulong MZ, Abu-Hassan MI, Abdul Razak AA, Embong A

Singapore Dent J, 1996 Jul;21(1):31-5.
PMID: 10597181

Records of 302 root-filled teeth treated by dental undergraduates were reviewed by four lecturers in the Department of Conservative Dentistry, University of Malaya. Preoperative and operative factors were evaluated for their association with postoperative pain experience of patients during the visit immediately after completion of biomechanical preparation. Eighty four percent of patients did not experience any pain after biomechanical preparation whilst the remaining 16 percent only complained of slight or moderate pain. The incidence of pain after biomechanical preparation is not high even when performed by inexperienced undergraduates. Teeth with a pre-existing painful condition had a higher chances of postoperative of pain. The incidence of postoperative pain was halved when teeth were associated with a sinus tract.

Matched MeSH terms: Pain Measurement
Fulltext Development of a stepping force analgesic meter for a rat arthritic model

Yam MF, Por LY, Peh KK, Ahmad M, Asmawi MZ, Ang LF, et al.

Sensors (Basel), 2011;11(5):5058-70.
PMID: 22163890 DOI: 10.3390/s110505058

Behavioural assessment of experimental pain is an essential method for analysing and measuring pain levels. Rodent models, which are widely used in behavioural tests, are often subject to external forces and stressful manipulations that cause variability of the parameters measured during the experiment. Therefore, these parameters may be inappropriate as indicators of pain. In this article, a stepping-force analgesimeter was designed to investigate the variations in the stepping force of rats in response to pain induction. The proposed apparatus incorporates new features, namely an infrared charge-coupled device (CCD) camera and a data acquisition system. The camera was able to capture the locomotion of the rats and synchronise the stepping force concurrently so that each step could be identified. Inter-day and intra-day precision and accuracy of each channel (there were a total of eight channels in the analgesimeter and each channel was connected to one load cell and one amplifier) were studied using different standard load weights. The validation studies for each channel also showed convincing results whereby intra-day and inter-day precision were less than 1% and accuracy was 99.36-100.36%. Consequently, an in vivo test was carried out using 16 rats (eight females and eight males). The rats were allowed to randomly walk across the sensor tunnel (the area that contained eight channels) and the stepping force and locomotion were recorded. A non-expert, but from a related research domain, was asked to differentiate the peaks of the front and hind paw, respectively. The results showed that of the total movement generated by the rats, 50.27 ± 3.90% in the case of the male rats and 62.20 ± 6.12% in that of the female rats had more than two peaks, a finding which does not substantiate the assumptions made in previous studies. This study also showed that there was a need to use the video display frame to distinguish between the front and hind paws in the case of 48.80 ± 4.01% of the male rats and 66.76 ± 5.35% of the female rats. Evidently the assumption held by current researchers regarding stepping force measurement is not realistic in terms of application, and as this study has shown, the use of a video display frame is essential for the identification of the front and hind paws through the peak signals.

Matched MeSH terms: Pain Measurement/instrumentation*; Pain Measurement/methods
Fulltext Peripheral Intravenous Catheterisation in Obstetric Patients in the Hand or Forearm Vein: A Randomised Trial

Tan PC, Mackeen A, Khong SY, Omar SZ, Noor Azmi MA

Sci Rep, 2016 Mar 18;6:23223.
PMID: 26987593 DOI: 10.1038/srep23223

A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers.

Matched MeSH terms: Pain Measurement
Fulltext Transient pain and discomfort when wearing high-heeled shoes

Almadhaani HMA, Goonetilleke RS, Wijeweera A, Jayaraman R, Ameersing L, Khandoker AH, et al.

Sci Rep, 2024 Apr 23;14(1):9291.
PMID: 38654097 DOI: 10.1038/s41598-024-59966-9

In the dynamic world of fashion, high-heeled footwear is revered as a symbol of style, luxury and sophistication. Yet, beneath the facade of elegance of classy footwear lies the harsh reality of discomfort and pain. Thus, this study aims to investigate the influence of wearing high-heeled shoes on the sensation of pain across different body regions over a period of 6 h. It involved fifty female participants, all habitual wearers of high-heeled shoes, aged between 20 and 30 years. Each participant kept a record of their perceptions of pain and discomfort every hour for a total of 6 h using a 0-10 pain scale with 0 indicating no pain and 10 indicating severe pain. The findings reveal a progressive rise in pain throughout wear, with the most intense pain reported in the back, calcaneus, and metatarsals. The analysis shows that after approximately 3.5 h, participants experience significant increases in pain levels. However, the relationship between heel height and pain is not linear. It appears that a heel height of 7.5 cm is the threshold where overall body pain becomes significant. The study suggests that a duration of 3.5 h of wear and a heel height of 7.5 cm serve as critical points to decrease overall body pain. Moreover, beyond this heel height, knee pain diminishes compared to other body areas possibly due to the shift towards a more neutral posture. The study findings, coupled with the recommendations, can assist footwear designers in crafting not only stylish but also comfortable shoes.

Matched MeSH terms: Pain Measurement
Fulltext Palm vitamin E and glucosamine sulphate in the treatment of osteoarthritis of the knee

Haflah NH, Jaarin K, Abdullah S, Omar M

Saudi Med J, 2009 Nov;30(11):1432-8.
PMID: 19882056

OBJECTIVE: To assess the efficacy of oral palm vitamin E in reducing symptoms of patients with osteoarthritis (OA) of the knee compared to oral glucosamine sulphate.
METHODS: This open study was carried out at the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia between March 2006 and November 2007. Seventy-nine patients were recruited to receive either 1.5 g oral glucosamine sulphate or 400 mg oral palm vitamin E for 6 months. Symptoms were assessed using the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and visual analogue scale (VAS).
RESULTS: Sixty-four patients completed the trial (vitamin E n=33, glucosamine sulfate n=31). After 6 months of treatment, both groups showed a significant improvement in WOMAC scale and significant reduction in the VAS score during standing and walking. There was no significant difference in WOMAC scale and VAS score between the 2 groups. Except for mild allergic reaction and abdominal discomfort in one patient, there were no other serious adverse effects reported. Serum malondialdehyde was significantly higher in the glucosamine group compared to palm vitamin E treated group at the end of the study. Serum of vitamin E was significantly higher in the palm vitamin E group compared to glucosamine.
CONCLUSION: The finding of this study suggests that oral palm vitamin E in a dose of 400 mg taken daily has a potential role in reducing symptoms of patients with OA of the knee. It may be just as effective as glucosamine sulphate in reducing the symptoms and free from serious side effects. Further study is required to ascertain the mechanism of action beside its antioxidant effect.

Matched MeSH terms: Pain Measurement
Fulltext Effects of passive joint mobilization on patients with knee osteoarthritis

Nor Azlin M, Lyn SK

Sains Malaysiana, 2011;40(12):1461-1465.

A controlled, single blinded experimental study was conducted to determine the effects of passive joint mobilization on pain and stairs ascending-descending time in subjects with knee osteoarthritis (OA knee). A total of 22 subjects aged 40 and above with mild and moderate OA knee were assigned to either passive knee mobilization plus conventional physiotherapy (experimental group) or conventional physiotherapy alone (control group). Both groups received 2 therapy sessions per week, for 4 weeks. A blinded assessor measured pain with Visual analogue scale and stairs ascending-descending time with Aggregated Locomotor Function test, at baseline and at week 4. There was a significant reduction in pain among subjects in the experimental group (18.07 mm, t = 3.48, p = 0.01) compared to the control group (6.66 mm, t = 0.44, p = 0.67). Non-significant clinical difference was found in stairs ascending-descending time between the two groups (i.e. 6.25s in the experimental group versus 6.78 s in the control group, F(1,10) = 0.70, p = 0.42). No significant correlation was found between pain score and stairs ascending-descending time, r = 0.34, p = 0.16. The addition of passive joint mobilization to conventional physiotherapy reduced pain but not stairs ascending-descending time among subjects with knee osteoarthritis.

Matched MeSH terms: Pain Measurement
Fulltext Efficacy of a topical anaesthetic on pain during scaling and root planing: a double blind split mouth pilot study in patients with periodontitis

Jacob PS, Sonia Nath

Sains Malaysiana, 2013;42(5):685-692.

Scaling and root planing is one of the most commonly performed procedures in a dental clinic. Most patients will consider the procedure to be causing discomfort or even pain. Intrasulcular topical application of anaesthesia will be preferred over injectable anaesthetic by patients for reduction of pain during scaling and root planing. A double blind split mouth pilot study was designed to find if pain was associated with scaling and root planing and to assess if application of topical anaesthesia reduced the pain. Twenty one patients were enrolled to compare the effect of intrasulcularly applied 20% benzocaine with a placebo in reducing pain during scaling and root planing. Heft Parker Visual analog scale was used to record the level of pain experienced by participants during instrumentation. Independent samples and paired samples t test were used for statistical analysis. There was significant pain associated with scaling and root planing with placebo over baseline (p<0.01). There was significant reduction in pain in benzocaine applied side when compared with placebo (p<0.001). Pain level approached baseline in benzocaine applied side. In this study, pain was effectively and significantly reduced with intrasulcular application of 20% benzocaine in periodontitis patients.

Matched MeSH terms: Pain Measurement
Contralateral Effects of Eccentric Exercise and DOMS of the Plantar Flexors: Evidence of Central Involvement

Marathamuthu S, Selvanayagam VS, Yusof A

Res Q Exerc Sport, 2020 Sep 25.
PMID: 32976088 DOI: 10.1080/02701367.2020.1819526

Purpose: Peripheral and central factors play important roles in the reduction of motor performance following damaging eccentric exercise and delayed onset muscle soreness (DOMS). Following this regime, contralateral limbs could also be affected; however, the factors involved remain inconclusive. The purpose of this study was to distinguish the peripheral and central factors following eccentric contraction and DOMS of the plantar flexors in treated and contralateral homologous limbs. Methods: Ten males (BMI = 25.08 ± 1.69kgm-2; age = 28.70 ± 4.24 years) were randomly assigned to experimental (DOM) or control (CON) groups. The DOM group performed a damaging eccentric exercise, while the CON group rested. Plasma creatine kinase (CK), pain rating scale (PRS), muscle stiffness, maximal voluntary contraction (MVC), and neural voluntary activation (VA) were measured before, after 10 min, and after 24, 48, and 72 hr on treated and contralateral limbs. Results: Following exercise, CK increased until after 48 hr, while PRS increased until after 72 hr compared to the CON group. Importantly, MVC was reduced at all time points, with the greatest reduction observed after 24 hr (-16%), while VA was affected until after 48 hr, with the greatest reduction at after 10 min (-7%). Interestingly, a "cross-over effect" was observed in contralateral limbs when PRS, MVC, and VA were negatively affected following the same pattern (time line) as treated limbs (-13% peak MVC reduction; -3.5% peak VA reduction). Conclusion: These findings suggest a substantial central contribution to the reduction in force immediately following eccentric exercise and to a lesser extent during the latter part of DOMS in both treated and contralateral limbs.

Matched MeSH terms: Pain Measurement
Cultural adaptation and psychometric assessment of Pain Catastrophizing Scale among young healthy Malay-speaking adults in military settings

Mohd Din FH, Hoe VC, Chan CK, Muslan MA

Qual Life Res, 2015 May;24(5):1275-80.
PMID: 25373928 DOI: 10.1007/s11136-014-0850-1

PURPOSE: The Pain Catastrophizing Scale (PCS) is designed to assess negative thoughts in response to pain. It is composed of three domains: helplessness, rumination, and magnification. We report on the translation, adaptation, and validation of scores on a Malay-speaking version of the PCS, the PCS-MY.
METHOD: Guidelines for the process of cross-cultural adaptations of assessment measures were implemented. A sample of 303 young military recruits participated in the study. Factor structure, reliability, and validity of scores on the PCS-MY were examined. Convergent validity was investigated with the Positive and Negative Affect Scale, Short-form 12 version 2, and Ryff's Psychological Well-being Scale.
RESULTS: Most participants were men, ranging in age from 19 to 26. The reliability of the PCS-MY scores was adequate (α = 0.90; mean inter-item correlation = 0.43). Confirmatory factor analysis showed that a modified version of the PCS-MY provided best fit estimates to the sample data. The PCS-MY total score was negatively correlated with mental well-being and positively correlated with negative affect (all ps < 0.001).
CONCLUSION: The PCS-MY was demonstrated to have adequate reliability and validity estimates in the study sample.

Matched MeSH terms: Pain Measurement*
Fulltext Health-related quality of life and its predictors among adults living with HIV/AIDS and receiving antiretroviral therapy in Pakistan

Ahmed A, Saqlain M, Bashir N, Dujaili J, Hashmi F, Mazhar F, et al.

Qual Life Res, 2021 Jun;30(6):1653-1664.
PMID: 33582967 DOI: 10.1007/s11136-021-02771-y

BACKGROUND: Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan.
METHODS: A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS).
RESULTS: Of the 602 patients included in the analyses, 59.5% (n = 358) reported no impairment in self-care, while 63.1% (n = 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age > 50 years; having primary and secondary education; > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART.
CONCLUSIONS: The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.

Matched MeSH terms: Pain Measurement
Fulltext Reducing painful experiences in neonates during routine minor procedures in special care nursery: A quality improvement project

Salwana Ku Md Saad, Koik, Boon Hong, Nur Faradilla Mohamad Bakri, Abdul Nasir Mohamed Abdul Kadher, Karniza Khalid

Q Bulletin, 2020;1(29):4-14.
MyJurnal

Neonates in Special Care Nursery (SCN) are constantly exposed to routine procedures that are painful. Repetitive painful exposures in neonates are known to have long-term deleterious effects that may surpass adulthood. A quality improvement project was designed to reduce the pain experienced by neonates during routine minor procedures in SCN unit of Hospital Tuanku Fauziah (HTF), a tertiary state hospital in Perlis, Malaysia. The Neonatal Infant Pain Scale (NIPS) was used as a pain assessment tool in neonates throughout the study. Several factors contributing to neonatal painful experience during routine procedures were identified, including poor awareness on neonatal pain perception, poor procedural etiquette among paediatric house officers, and lack of non-pharmacological pain relief used during the procedures. Interventional measures included adjunctive use of non-nutritive sucking via orthodontic Avent® pacifier, use of adjustable swaddling blanket via SwaddleMe® size S, and introduction of a clinical training module for the house officers. There were 159 neonates recruited in the pre-intervention period and 163 neonates evaluated in the post-intervention period. Our study revealed a significant decrease in neonatal painful experience during routine procedures, from 49.7% to 17.8% (p

Matched MeSH terms: Pain Measurement
Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Bhardwaj A, Nagandla K

Postgrad Med J, 2014 Aug;90(1066):450-60.
PMID: 24904047 DOI: 10.1136/postgradmedj-2013-132377

Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.

Matched MeSH terms: Pain Measurement
Fulltext The impact of dyspepsia on symptom severity and quality of life in adults with headache

Tai ML, Norhatta N, Goh KJ, Moy FM, Sujarita R, Asraff AA, et al.

PLoS One, 2015;10(1):e0115838.
PMID: 25629323 DOI: 10.1371/journal.pone.0115838

BACKGROUND: Dyspepsia and headache frequently co-exist, but the clinical implication of this association is uncertain. We planned to examine the prevalence and impact of dyspepsia in adults with headache.
METHODS: A cross-sectional study was conducted in a secondary care setting. Clinical, psychological and health-related quality of life (HRQOL) data were compared between subjects with headache and controls (non-headache subjects). The impact of dyspepsia was analysed further in subjects with headache alone.
RESULTS: 280 subjects (93 cases with headache and 187 matched controls) were recruited. The following baseline characteristics of subjects were as follows: mean age 45.0 ± 17.3 years, 57.0% females and ethnic distribution-Malaysian = 45 (48.4%), Chinese n = 24 (25.8%) and Indians n = 24 (25.8%). Headache sub-types among cases with headache were as follows: tension-type headache (TTH) n = 53 (57.0%) and migraine n = 40 (43.0%). Dyspepsia was more prevalent in cases with headache compared to controls (25.8% vs 12.8%, p = 0.011), and headache was independently associated with dyspepsia (OR 2.75, 95% CI 1.39-5.43). Among cases with headache, there was a trend towards a higher prevalence of dyspepsia in those with migraine (27.5%) compared to TTH (24.5%). Subjects with headache and dyspepsia, compared to those with headache alone, had a greater severity of headache symptoms (63.67 ± 22.85 mm vs 51.20 ± 24.0 mm VAS, p = 0.029). Overall HRQOL scores were lower in headache subjects with dyspepsia (EQ-5D summary score 0.82 ± 0.18 vs 0.90 ± 0.16, p = 0.037 and EQ-5D VAS 62.08 ± 17.50 mm vs 72.62 ± 18.85 mm, p = 0.018), compared to those without dyspepsia.
CONCLUSION: Dyspepsia is associated with more severe headache symptoms and results in a lower HRQOL in patients with headache.

Matched MeSH terms: Pain Measurement

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