Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transdermal fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical/diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patient's analgesic demand was drastically reduced and described her pain as "1 to 3" of "10". Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during fecal 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.
Ra, Seung Won;Park, Soon Eun;Lee, Hyung Kwan;Han, Il Sang;Park, Se Hun
Journal of Yeungnam Medical Science
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제37권1호
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pp.67-72
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2020
Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient's symptoms improved without the occurrence of any complications.
This study assessed the effects of Qi therapy (QT) on premenstrual symptoms in women with premenstrual syndrome (PMS). Forty-six college women were randomly allocated to receive QT (QT group: n=23) or complete diary of PMS (control group: n=22, 1 was dropped out). The experimental group receives 12 minutes Qi therapy for 5 times (7, 4, 1 day before and 7, 14 day after menstruation), and control group relaxed in the same procedure with experimental group. We measured pain, depression and anxiety level with visual analogue scale (VAS) to investigate participants responses. There were significant reductions on pain, depression and anxiety in QT group compared with control. These findings suggest that Qi therapy may have a role in helping the women with PMS to cope with their pain, depression and anxiety symptoms.
Background: Patients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP. Methods: Using a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on ${\ddot{O}}$st's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis. Results: The relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy. Conclusions: Regarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.
The purpose of this pilot study was to identify the effects of hand moxibustion therapy to decrease pain and relieve coldness of the body in women who had a hysterectomy. The conceptual framework of this study was derived from Ying-Yang, Khi and other corresponding theories. The data were collected from February to May 1997. A Graphic Rating scale was used to measure the degree of pain and Digital Infrared Thermographic Imaging(D.I.T.I) was used to examine the degree of coldness. The subjects were women who resided in Seoul and had a hysterectomy within five years. An experimental group was composed of five women who received moxibustion and a control group was composed of five who did not. The research procedure began with having both the experimental group and control group describe their general characteristics and the degree of pain they perceived. Then, Digital Infrared Thermographic Imaging(D.I.T.I) was conducted. Moxibustion was only given to the experimental group on both hands twice every day for a total of five weeks. Their perception of pain and D.I.T.I were examined weekly. The control group received no therapy. After finishing therapy, the perception of pain and D.I.T.I for both groups were also measured. According to this study, moxibustion therapy resulted in a change of body temperature on the right shoulder joint(p=0.00074), abdomen(p= 0.0047), waist(p=0.0068) and hands(p=0.0317) respectively. Also, the study results showed significant decrease (p=0.0001) in pain over time and significant improvement over body coldness.
Purpose: The purpose of this study was to examine the effects of a preference music therapy on anxiety and pain of cystoscopy. Methods: This study was performed using the quasi-experimental study design with non-equivalent control group pre-test and post-test. Total of 76 adult clients admitted to a tertiary hospital located in Daegu, South Korea were selected by convenience sampling 19 in the control and 57 in the experimental group. The data were analyzed by $x^2$, t-test, paired t-test, and repeated measures ANOVA using SPSS 17.0. Results: Implementing a preference music therapy was found to be effective in reducing anxiety level before cystoscopy in the present study. However, there were no significant effects of this preference music therapy in reducing pain and anxiety during cystoscopy. In addition, there were no significant effects of a preference music therapy on the patients' satisfaction of the anxiety, discomfort, and pain relieving. Conclusion: The findings support that implementing a preference music therapy may reduce anxiety before the cyctoscopy procedure. Therefore, it can be suggested that a preference music therapy needs to be consider-ed as a regular nursing intervention to reduce patient anxiety level before cystoscopy.
Kim, Maru;Kim, Joongsuck;Kim, Sung Jeep;Cho, Hang Joo
Journal of Trauma and Injury
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제30권2호
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pp.47-50
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2017
A 21-year-old male visited our emergency room. He could not remember the mechanism of injury. He was found beside a motorcycle. Initial vital sign was stable. Observation and conservative treatment were planned at the intensive care unit (ICU). On the third day at ICU, he complained sudden flank pain. It was colicky and hard to control. Without the pain, he had no specific symptom, sign, or laboratory findings. On computed tomography, renal pelvis was filled with hematoma which induced hydronephrosis. Double-J catheter and percutaneous nephrostomy was implemented by an intervention radiologist. Hematome in the renal pelvis was aspirated during the procedure. Symptom of the patient was subsided after the procedure. He was discharged without specific complications.
Coping patterns were investigated in a sample of 126 patients with chronic low back pain by means of self-reported questionnaire. Based on the previous researches, coping pat terns were divided into the active cognitive coping, the active behavioral coping, the passive cognitive coping, and the passive behavioral coping. While all the above coping patterns were used, the passive behavioral coping was found to be used most frequently. Six subgroups were identified by cluster analytic procedure using their scores of the coping scale : active cognitive coper, general active coper, passive behavioral coper, general passive coper, multidimensional coper, and multi dimensional non-coper. Six subgroups were compared regarding locus of control, self-efficacy, pain and demographic variables. Distinct differences appeared among subgroups in internal locus of control, self-efficacy, and pain. General active coper and active cognitive coper had higher internal locus of control, higher self-efficacy, and lower pain. General passive coper and multidimensional non-coper had lower internal locus of control, lower self-efficacy, and higher pain. Passive behavioral coper had higher internal locus of control, lower self-efficacy, and higher pain. It supports the concept of learned helplessness due to prior experiences. Multi dimensional coper had higher internal, higher powerful others, and higher self-efficacy. So it corresponds to 'believer in control' group Identified by Wallston et at(1982). Unexpectedly this group also complained more pain. It could be interpreted in two ways. The more coping methods they use, the more they complain pain ; which is the result of Folkman et al (1986). Or they might be typical 'yea sayers'. These unique groups-passive behavioral coper and multidimensional coper-identified by this study supports the suggestion of Wallston et al(1982), about locus of control : individual's pattern of responses across the three scales may be more predictive than his or her scores on each of the scale seperately. The fact that passive coping was used more than active coping also suggests that self controlled active co ping is encouraged to chronic patients as well as acute patients. And it is necessary to articulate the coping scale and self-efficacy scale. It is also necessary to study the relationship of coping and adjustment by experimental design.
Background: Mandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery. Methods: This double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded. Results: The results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar. Conclusion: It is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.
Yoon, Ji Young;Park, Joo Hyun;Lee, Kwang Jin;Kim, Hyong Suk;Rhee, Sung-Min;Oh, Joo Han
The Korean Journal of Pain
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제33권4호
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pp.344-351
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2020
Background: The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing. Methods: This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively. Results: At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°; P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999). Conclusions: FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.
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