Wednesday, 31 March 2021 07:20

Prevalence of pain in adult patients

Aim: This study aimed to determine the frequency and characteristics of pain in inpatients. 

Material and Methods: This study was conducted as an analytical and cross-sectional type of time prevalence on 25-26-29-30 July 2019, including 127 patients hospitalized in a public hospital in Istanbul. Data were collected through the Introductory Information Form, the Brief Pain Inventory (BPI), and the Revised American Pain Society Patient Results Questionnaire through face-to-face interviews. The mean, percentage distribution and standard deviation values were calculated using descriptive statistical methods. First of all, the Kolmogorov-Smirnov, Shapiro Wilk-W tests were performed and the normal distribution of the data was examined. According to these results, nonparametric tests were applied. The Mann-Whitney U test was used between two independent groups, the Kruskal-Wallis test and Spearman’s Correlation analysis were used between more than two independent groups. 

Results: As a result of the analysis of the obtained data, the average age of the participants included in the study was 48.13 ± 16.88 years. In addition, it was found that maximum 37% (n = 47) were primary school graduates and 53.5% (n = 68) were women. It was determined that 44.9% (n = 57) of the participants preferred most digestive system and surgical diseases as medical diagnosis and treatment, and 59.8% (n = 76) preferred paracetamol as analgesic use. It was determined that 21.3% (n = 27) of the pain they experienced was a stinging type. It was found that the most pain was felt in the abdomen and pelvic region in 56.7% (n = 72). The Brief Pain Inventory total score average was 5.80 ± 1.85 and the pain prevalence was 76.37%.

Discussion: The prevalence of pain in adult patients in Turkey, according to the survey results, is quite high. Despite the high prevalence of pain, moderate pain intensity may be associated with ethnic and socioeconomic factors in the perception of pain. It is recommended that health professionals who play an important role in relieving or eliminating pain, increase their knowledge of pain, and coping with pain.

Aim: This study was planned to examine the effects of surgical menopause on physical, psychosocial and cognitive functions.

Material and Methods: The study included 25 women aged 40-54 years.  The participants consisted of healthy individuals who have not yet entered menopause, who have been diagnosed with surgical menopause and who were literate. Before surgical menopause, all participants were assessed using a form including demographic information for demographic data; 5 times sit to stand test, sit and reach test, half squat test, hand grip strength measurement test, Visual Analogue Scale for physical functions; Perceived Stress Scale, Center for Epidemiological Study Depression Scale, Hamilton Anxiety Rating Scale, Women’s Health Initiative Insomnia Scale for psychosocial functions; and Montreal Cognitive Assessment Scale for cognitive functions. All participants were reevaluated after 3 months of surgical menopause.

Results: The mean age of the participants was 45.96±4.26 years and the mean body mass index was 30.57±4.50 kg/cm². In physical function tests, psychosocial functions, cognitive functions there was no statistically significant difference between the pre- and postoperative test results of the participants (p>0.05). The decrease in spinal pain intensity of the participants was statistically significant compared to the preoperative period (p<0.05). After surgery, the participants’ scores on the CES-Depression Scale were decreased and the difference was statistically significant (p<0.05).

Discussion: After surgical menopause, participants’ depression levels and spinal pain improved. Surgical menopause did not affect the participants’ other physical, psychosocial and cognitive functions of.

Aim: The aim of this study was to evaluate the effect of the home exercise program on the pain of physiotherapy and rehabilitation outpatients.

Material and Method: The study included 316 patients with low back, neck, shoulder, and knee pain aged 18-65 years. A personal information form was filled out to obtain demographic information about these patients. After exercise training given by the physiotherapists, the pain of the patients was evaluated by a visual analog scale (VAS). After 4 weeks, the patients were called by telephone and questioned whether they were doing the exercises and their pain severity.

Results: Among patients, 54,4% (172) were female; 72,8% of the patients with a mean age of 39.85±13.77 years were married, 40,8% were primary school graduates and 37,3% were housewives. One hundred three patients applied (32,6%) with neck pain, 132 (41,8%) with low back pain, 29 (9,2%) with shoulder pain and 52 (16,5%) with knee pain. It was observed that 55.4% (175) of the patients who were prescribed training did not perform their exercises. Among patients who exercised, 69,6% did not use analgesics in this process. A statistically significant result was found when the before and after exercise VAS data of participants who did exercise and those who did not were compared (p=0.001).

Discussion: In the study by Kılıç, more than half of the patients who exercised benefited from the exercises they performed and stated that the exercise decreased problems such as pain, locking, fatigue, and limitation of movement due to disease. It was determined that the patients who completed the exercise program had less pain. Regular exercise programs will lead to positive outcomes.

Aim: Children’s perception of pain may vary depending on defenselessness, negative and exaggerated behavior, level of persuasion, personality characteristics, and previously experienced negative experiences. This study was designed to investigate the relationship between anxiety and postoperative pain perception of children and the family’s anxiety about the child’s pain and negative attitudes on the effects of the pain. 

Material and Methods: Thirty-five patients undergoing appendectomy between August-December 2017 were included in this prospective study. Seven patients were excluded because of incongruity. Face, leg, activity, cry, consolidation (FLACC), preoperative anxiety scale of Yale, and Post-Anesthetic Delirium scale were applied. In the postoperative period, parents and children were asked to complete a pain questionnaire.

Results: It is found that, as family education level increased, the anxiety of both children and parents decreased. The parents were found to have fewer levels of rumination as the level of education increased when the effect of postoperative analgesia selection on the visual analog pain scale (VPS) was investigated, there was a statistically significant difference between pain VPS scores only after surgery. It was found that mothers were more anxious than fathers. A moderately positive correlation was found between the VPS score and the child and parental rumination scale scores. It was seen that the education level of the family had a positive effect on the pain perception of the child. 

Discussion: The results of the surgical experience in the long-term memory revealed that the children had a comfortable postoperative period and that they did not think much about the operation, but that they would be afraid to undergo surgery again.

Aim: The purpose of our study is to evaluate the effects of platelet- rich plasma (PRP), Hyaluronic Acid (HA), and their combination treatments on pain and functional scores in the cases of mild to moderate osteoarthritis.  

Materials and Methods: One hundred twenty patients receiving PRP and/or HA injection in knee joint space were retrospectively evaluated. The mean age of the patients was 59.5± 5 years. The mean length of follow-up time was 6 months. Twenty-two patients received PRP first and after 15 days they got HA injection while 26 patients received HA first and then PRP 15 days after the first injection. Thirty-three patients were given a single dose of PRP and 39 patients were treated only with HA injection. Patients were then evaluated with WOMAC and VAS scoring systems.

Results: A statistical comparison of the groups shows that the HA+PRP group achieved significantly better clinical results. Patients receiving only HA injection had significantly worse clinical outcomes while patients receiving only PRP treatment and PRP+HA had similar results. 

Discussion: In conclusion, PRP and HA combination appears to be a potentially effective treatment modality in knee osteoarthritis.

 

Aim: The aim of this study was to investigate the effect of the use of ondansetron and dexamethasone as an antiemetic in laparoscopic cholecystectomy surgery on postoperative tramadol consumption.

Material and Method: This prospective, randomized, double-blind study included 90 ASA I-II patients, aged 18-60 years who had planned to undergo laparo- scopic cholecystectomy surgery. The patients’ ECG, blood pressure, cardiac rate, and peripheral oxygen saturation were monitored. Prior to anesthesia induc- tion, an injection was administered from two syringes, which had been prepared with medications by another person. Intravenous injection of 4 mg of ondan- setron (2 ml) and saline (2 ml) was administered to Group O (n=25), injection of 8 mg of dexamethasone (2 ml) and saline (2 ml) was administered to Group D (n=25) and injection of 4 mg of ondansetron (2 ml) and 8 mg of dexamethasone (2 ml) was administered to Group OD (n=25). Standard anesthesia induction was performed on all patients and was maintained with 1-2% sevoflurane, 50% nitrogen protoxide, and 50% oxygen. Immediately after the gall bladder was re- moved, a patient-controlled analgesia (PCA) device was loaded with 1.5 mg/kg tramadol. The PCA device was set to a bolus dose of 30 mg with a locked period of 10 min. In all of the groups, hemodynamic changes, pain scores (numeric rating scale -NRS), analgesia consumption (mg), potential side-effects of nausea and vomiting and sedation scores were evaluated at postoperative 5, 15, 30, 45 and 60 minutes in the recovery room and at 4, 8, 12 and 24 hours in the ward.

Results: No statistically significant difference was determined with respect to the heart rate, mean arterial pressure and oxygen saturation values in the 24-hour postoperative follow-up period (p>0.05). The consumption of total tramadol was lower compared to that of ondansetron (p=0.002). In patients who received both dexamethasone and ondansetron, the pain scores and total tramadol consumption were statistically significantly lower from the postoperative 45th minute onwards compared to other groups (p<0.001).

Discussion: The combination of ondansetron and dexamethasone was more effective in preventing severe problems of nausea, vomiting, and pain following laparoscopic cholecystectomy compared to the use of ondansetron or dexamethasone alone.

Aim: Biceps tendinitis is characterized by inflammation of the biceps long head, and treatment options include various conservative and surgical methods. Kinesiotaping (KT) has benefited in reducing pain and providing motor control in various shoulder disorders. The aim of this study is to investigate the effectiveness of KT application in patients with biceps tendinitis in terms of pain, pain threshold, upper extremity functionality level and quality of life.

Materials and Methods: Eighty patients with biceps tendinitis were divided into two groups randomly, each comprising 40 patients. The study group received KT with an exercise program, the control group received an exercise program only. Pre- and post-treatment evaluations were conducted. Pain threshold was evaluated with a digital algometer, pain severity with visual analog scale (VAS), functional capacity with the disabilities of the arm, shoulder and hand score (Q-DASH) and quality of life with Nottingham Health Profile (NHP). 

Results: The mean duration of the symptoms was 4.5 months and the mean age was 45.80±8.48 years. Pain intensity decreased during activity (p<0.001) and pain thresholds increased (p<0.001) in the KT group. Q-DASH scores improved significantly in patients in the KT group, there was a less significance in the control group (p<0.001, 0.043). The NHP scores except social isolation improved in all sub-parameters of the KT group and there was no significance in control group (p>0.05, 0.003, 0.012, 0.023, 0.225, 0.035, 0.029, 0.006).

Discussion: KT application decreases pain and increases the functional capacity level and can also play a role in improving the general quality of life in biceps tendinitis treatment.

Aim: The aim of this study was to compare the cervical muscle endurance of young people with and without neck pain. The second aim of this study was to explore the gender differences in people with neck pain for neck muscle endurance.  

Material and Methods: The study included 130 university students aged between 18 to 25 years (55 females, 75 males).  Forty-two of those students who have neck pain (NP) at least 3 months and 88 of the students without neck pain (C) constituted the sample. Pain intensity was assessed with Visual Analog Scale (VAS).  Isometric neck muscle endurance of the participants was assessed using cervical flexor (NF) and extensor (NE) muscles endurance tests.

Results: The main pain intensity of the subjects with NP was 4,19±1.92. For all subjects, the mean endurance of both NF (p=0.03) and NE (p=0.05) muscles of the subjects without pain was higher compared with subjects with NP. When the analysis was classified by gender, male subjects without pain had higher NF (p=0.02)  and NE (p=0.002)  muscle endurance than male subjects with pain. On the other hand, there were no significant differences between female subjects with and without NP (p>0.05).  

Discussion: These findings suggest that neck flexor and extensor muscle endurance are affected by neck pain. On the other hand, gender is a significant factor for neck muscle endurance in subjects with neck pain. Further investigations are needed to have a wide data to consider the gender and pain for neck muscle endurance.

Aim: In this study, we aimed to compare pain, functional capacity, and quality of life of patients with knee osteoarthritis (OA), determine the factors affecting them, and investigate the effect of over-the-counter (OTC)-containing herbal supplementation on daily living activities in patients with knee OA. 

Materials and Methods: The study included 102 patients with the diagnosis of knee OA according to the American College of Rheumatology (ACR) criteria who were admitted to our orthopedics and traumatology outpatient clinic between March 2019 and September 2019.  Demographic data were recorded. The visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), medical outcomes study short-form health survey (SF-36) were used. The Kellgren-Lawrence scale was used for radiological evaluation. Information about the patients was determined by the questionnaire method and the patients were evaluated according to recruitment/exclusion criteria. In the study group, 102 patients with knee OA were included. On the other hand, 100 patients received a placebo as a control group. After three months of OTC supplementation, daily life activities and functional tests were performed and data were collected. Both subjective and objective data were calculated, compared, and analyzed. 

Results: It was observed that more than 80% of the patients with OA included in the study relieved pain with our food supplement components. There was an improvment in functional abilities of the patients with chronic OA as compared to standard medical treatment, and the pain level decreased significantly with test scores and scales after supplementary foods. The secondary endpoint was also noticed. We noticed that our subjects actually lost an average of 1.5 kg over the course of the study. 

Discussion: OA is the most common form of arthritis and the leading cause of disability among middle-aged and elderly people. We can develop theoretical strategies for primary prevention of joint damage through the reduction of obesity and joint trauma in particular. Effective chondroprotective therapies will be most useful when applied to high-risk individuals before the emergence of symptomatic OA.  

Conclusion: We concluded that food supplementation that was used in our study seemed to be beneficial in patients with knee ailments such as OA. It was equally interesting to observe that the majority of patients lost weight while taking these supplements.  Although the study was underpowered, it shed light on supplements containing glucosamine. We believe that further larger series studies in the near future can help us to obtain more objective findings.

Aim: The aim of this study was to investigate the efficiency of extracorporeal shockwave therapy (ESWT) in the treatment of Carpal tunnel syndrome (CTS).  Material and Method: In the study 49 hand with the diagnosis of CTS were included. Patients were randomized in ESWT (n=29 hands) and sham (n=20 hands)  groups. Patients were randomly allocated to receive 1 session per week for 3 weeks of either sham or active ESWT. Patients were evaluated before the treatment,  and at the end of the first week, first month and third month after the end of the treatment session with Boston Scale, Visual Analogue Scale for pain  and paresthesia assessment, hand grip strength, and electroneurophysiological parameters. Results: A total of 38 patients completed the study with 29 wrists  in active ESWT and 20 wrists in sham ESWT groups. Groups were similar in age, sex, duration of symptoms, hand grip strength, and electrodiagnostic parameters  (P>0.05). In both groups, significant improvements were observed in VAS, Boston Scale, and hand grip strength after treatment. In both groups, there was  no significant difference in none of the clinical and electrodiagnostic parameters (p>0.05). Discussion: Although ESWT was effective in symptoms in CTS this  efficacy isn’t superior to placebo. Our results indicated that ESWT was effective in pain and clinical variables in CTS. Wider and high-quality studies are needed  to further demonstrate the effectiveness of ESWT in the treatment of CTS.

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