bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serial Analgesic Consumptions and Predictors of Intravenous Patient-controlled Analgesia with Cluster Analysis
Authors: Lin Shih-Pin , Chang Kuang-Yi , Tsou Mei-Yung , Chen Tony Hsiu-Hsi 
Published: December 2015

Objectives:
To elucidate the dynamics of analgesic consumption regarding intravenous patient controlled analgesia (IVPCA) during postoperative period is rather complex partly due to between-patient variation and partly due to within-patient variation. A statistical method was proposed to classify serial analgesic consumption into different classifications that were further taken as the multiple outcomes on which to explore the associated predictors.

Methods:
We retrospectively included 3284 patients administrated by IVPCA for 3 days after surgery. A repeated measurement design corresponding to serial analgesic consumption variables defined as six-hour total analgesic consumptions was adopted. After determining the numbers of clusters, serial analgesic consumptions were classified into several homogeneous subgroups. Factors associated with new classifications were identified and quantified with a multinominal logistic regression model.

Results:
Three distinct analgesic classifications were aggregated, including “high”, ”middle” and “low” level of analgesic consumption of IVPCA. The mean analgesic consumptions on 12 successive analgesic consumptions at 6-hour interval of each classification consistently revealed a decreasing trend. As the trends were almost parallel with time, this suggests the time-invariant proportionality of analgesic consumption between the levels of analgesic consumption of IVPCA. Patient’s characteristics, like age, gender, weight, height, and cancer status, were significant factors associated with analgesic classifications. Surgical sites had great impacts on analgesic classifications.

Discussion:
The serial analgesic consumptions were simplified into 3 analgesic consumptions classifications. The identified predictors are useful to recognize patient’s analgesic classifications before using IVPCA. This study explored a new approach to analysing dynamic changes of postoperative analgesic consumptions.
Optimizing Nociceptive Flexion Reflex (NFR) Scoring Criteria by Adjusting for Noise and Reflex Properties and Sampling Rate
Authors: Lichtner Gregor , Hösl Teresa M. , Jakuscheit Axel , Jurth Carlo , von Dincklage Falk 
Published: December 2015

Objective:
To reanalyze scoring criteria for automatic detection of nociceptive flexion reflexes (NFRs) in electromyography (EMG) recordings and to improve detection accuracy by accounting for multiple characteristics of the recordings, such as baseline noise level or sampling rate.

Methods:
Single scoring criteria for the NFR were reanalyzed and validated against an independent data set. To account for influences on the single scoring criteria, such as the baseline noise, multivariate classification models were derived.

Results:
Reanalysis of single scoring criteria yielded significantly lower threshold values than previously reported. The threshold value of the best-performing single scoring criterion, the NFR Interval Peak z score, was found to be strongly dependent on the level of baseline noise and the EMG sampling rate. Multivariate classification models could reduce the number of incorrectly classified recordings in an independent data set by 25% to 37% compared with the best-performing single scoring criterion.

Discussion:
The automatic detection of reflex responses in electromyograms can be significantly improved by including multiple reflex, baseline, and EMG characteristics into a classification model. These findings should help to improve the accuracy of currently used standard measurement algorithms and algorithms engineered toward specific properties, such as short measurements or less induced pain for the patients.
Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the Management of Low Back Pain
Authors: Slade Susan C. , Kent Peter , Patel Shilpa , Bucknall Tracey , Buchbinder Rachelle 
Published: December 2015

Introduction:
Despite the availability of evidence-based guidelines for the management of low back pain (LBP) that contain consistent messages, large evidence-practice gaps in primary care remain.

Objectives:
To perform a systematic review and metasynthesis of qualitative studies that have explored primary care clinicians’ perceptions and beliefs about guidelines for LBP, including perceived enablers and barriers to guideline adherence.

Methods:
Studies investigating perceptions and beliefs about LBP guidelines were included if participants were primary care clinicians and qualitative methods had been used for both data collection and analysis. We searched major databases up to July 2014. Pairs of reviewers independently screened titles and abstracts, extracted data, appraised method quality using the CASP checklist, conducted thematic analysis, and synthesized the results in narrative format.

Results:
Seventeen studies, with a total of 705 participants, were included. We identified 3 key emergent themes and 8 subthemes: (1) guideline implementation and adherence beliefs and perceptions; (2) maintaining the patient-clinician relationship with imaging referrals; and (3) barriers to guideline implementation. Clinicians believed that guidelines were categorical, prescriptive, and constrained professional practice; however, popular clinical practices superseded the guidelines. Imaging referrals were used to manage consultations and to obtain definitive diagnoses. Clinicians’ perceptions reflected a lack of content knowledge and understanding of how guidelines are developed.

Discussion:
Addressing misconceptions and other barriers to uptake of evidence-based guidelines for managing LBP is needed to improve knowledge transfer and close the evidence-practice gap in the treatment of this common condition.
Parent Attitudes Toward Pain Management for Childhood Immunizations
Authors: Connelly Mark , Wallace Dustin P. , Williams Kristi , Parker JoLynn , Schurman Jennifer V. 
Published: December 2015

Objectives:
Evidence-based pain-limiting strategies for pediatric immunizations remain underutilized, with barriers identified to date mostly pertaining to health care providers and systems of care. The present study sought to quantify and investigate parent attitudes toward pain management as another potential barrier to the routine use of pain-mitigating strategies during immunizations.

Materials and Methods:
Questionnaires measuring parent attitudes, willingness to pay, and perceived barriers for using pain management for immunizations were completed by 259 parent/guardians of children ages 0 to 5 years attending appointments at an urban primary care clinic in the Midwestern United States.

Results:
Parent attitudes toward pain management for immunization were relatively normally distributed and varied from strongly positive to negative, with 33% of parents disagreeing that they were concerned about the pain their child may experience and 50% agreeing that there are no lasting negative effects from immunization pain. Negative parent attitudes were associated with willingness to spend less in money or time for pain management and with greater perceived significance of cost, time, and other barriers for using pain-mitigating strategies.

Discussion:
Some parents perceive limited value in trying to reduce pain during immunizations such that they may be hesitant to invest much time or effort in interventions. Greater success of translating evidence-based pain management into practice therefore may require accounting for differences in parent attitudes by tailoring educational efforts and pain management options accordingly.
Coping is Important for Spouses Too
Authors: Suso-Ribera Carlos , Yakobov Esther , Ribera-Canudas Mª Victoria 
Published: December 2015

Introduction:
Living with a patient with chronic pain is now known to have a negative impact on physical and mental health of the caregivers. Research indicates that adaptive coping strategies can reduce the burden that pain has on patients. Yet, it is unknown whether coping strategies can also affect the physical and mental health of the spouses of patients with chronic pain. In the present research, we investigated the role of coping strategies used by spouses of patients with pain in the relationship between the pain intensity of the patients and the physical and mental health of their spouses.

Methods:
The study comprised 195 heterosexual couples. About 41% of spouses were females.

Results:
Our results showed that being older, having a lower educational level, having a negative orientation toward problems, and using impulsive strategies to cope when in difficult situations contributed to poorer physical health of spouses. A poorer mental health status of spouses was associated with being negatively oriented toward problems, being a female, and being a caregiver of mentally distressed patient. In addition, it was found that the impulsive-careless coping strategy used by the spouses moderated the relationship between patients’ pain severity and physical health of their spouses. At low levels of patients’ pain intensity as rated by spouses, spouses reported similar levels of physical health irrespective of coping ratings. Conversely, at high levels of patients’ pain intensity as rated by spouses, poorer physical health was reported by spouses scoring high on impulsive-careless coping.

Discussion:
Implications for clinical practice are discussed. Our findings suggest that screening for coping strategies used by spouses of patients with pain might complement clinical interventions aimed at promoting the physical and mental health of patients and their partners.
Sleep Problems are Associated With Chronic Pain Over and Above Mutual Associations With Depression and Catastrophizing
Authors: Roberts Mary B. , Drummond Peter D. 
Published: December 2015

Introduction:
Pain, mood problems, and sleeping difficulties are often comorbid and contribute to reduced physical function and quality of life for those with chronic pain. However, the way in which these factors interact is unclear. Until recently it was thought that the effect of sleep on pain and physical function was simply a result of its common association with mood problems. However, a growing body of research suggests that sleep may have a unique contribution.

Objectives:
The aim of this study was to determine whether sleep disturbances were associated with pain and poor physical function independent of psychological distress in patients attending a tertiary pain medicine unit.

Materials and Methods:
101 patients with chronic pain completed a set of questionnaires measuring pain, sleep, and mood, and also completed a selection of physical assessments conducted by a physiotherapist.

Results:
In total, 75.2% of participants had insomnia and 84.3% reported the presence of at least 1 sleep problem. Significant positive correlations with pain were detected for depression, catastrophizing, insomnia, short sleep duration, and poor sleep quality. Sleep duration had a significant independent association with pain after accounting for depression and catastrophizing. Sleep duration also had an independent association with physical function after accounting for pain and catastrophizing.

Conclusions:
Given that sleep has an important and unique contribution to pain and physical function, it is important that sleep disturbances are addressed both in the assessment and treatment of chronic pain.
Comparison Between the Effects of Intravenous Morphine, Tramadol, and Ketorolac on Stress and Immune Responses in Patients Undergoing Modified Radical Mastectomy
Authors: Bakr Mohamed A.-E.-M. , Amr Samy A.-E. R. , Mohamed Sahar A. , Hamed Hosny B. , Abd EL-Rahman Ahmad M. , Mostafa Mohamed A. M. , El Sherif Fatma A. 
Published: December 2015

Objectives:
Analgesics had been suspected of impairing various immune functions either directly or indirectly. Our primary objective was to compare the effects of intravenous (IV) morphine, tramadol, and ketorolac on stress and immune responses in patients who underwent modified radical mastectomy.

Patients:
Sixty patients randomly assigned to receive IV morphine 5 mg (group M, n=20), tramadol 100 mg (group T, n=20), or ketorolac 60 mg (group K, n=20) at the end of surgery.

Methods:
Serum cortisol, prolactin were measured immediately, 40 minutes, and 24 hours postoperatively. Expressions of peripheral T lymphocytes (CD3+, CD3+CD4+, CD3+CD8+) and natural killer cells (CD3+, CD56+) were measured as percentages of total lymphocytes by flow cytometry immediately, 90 minutes, and 24 hours postoperatively.

Results:
After 40 minutes, cortisol level increased but prolactin decreased significantly (P=0.001), then both decreased after 24 hours (P=0.001) compared with baseline within the 3 groups. CD3, CD4, CD8, and CD56 significantly decreased at 90 minutes and 24 hours (P≤0.033) compared with baseline in the 3 groups. CD4, CD8, and CD56 significantly decreased in group M, compared with group T and K (P≤0.016) and CD3, CD8, and CD56 in group T compared with group K at 90 minutes (P≤0.024) postoperatively. After 24 hours, CD4, and CD8 decreased in group M compared with group T (P≤0.048) and CD4 and CD56 in groups M and T compared with group K (P≤0.049).

Conclusions:
IV morphine, tramadol, and ketorolac suppressed stress and immune responses. Ketorolac was the least immunosuppressive among the 3 drugs.
Does Evidence Support the Use of Neural Tissue Management to Reduce Pain and Disability in Nerve-related Chronic Musculoskeletal Pain?
Authors: Su Yunfeng , Lim Edwin Choon Wyn 
Published: December 2015

Objectives:
In nerve-related chronic musculoskeletal (MS) disorders, neural tissue management is used to relieve pain by balancing the relative movement of neural tissues and their surrounding tissues. To date, there has not been any review evaluating the magnitude of this treatment effect in nerve-related chronic MS pain. The aim of this review was to compare pain and disability in individuals with nerve-related chronic MS pain who were treated with neural tissue management with those who received minimal or other treatment approaches.

Methods:
Searches of 8 major electronic databases were conducted, and data on pain and disability scores were extracted. Meta-analyses (where possible) with either a fixed-effect(s) or random-effect(s) model, standardized mean differences (SMDs), and tests of heterogeneity were performed.

Results:
Twenty clinically controlled trials were identified and included in the meta-analyses. When compared with minimal intervention, neural mobilization provided superior pain relief (pooled SMD=−0.77; 95% confidence interval [CI], −1.11 to −0.42; P<0.0001), and reduction in disability (pooled SMD=−1.06; 95% CI, −1.97 to −0.14; P=0.02), after post hoc sensitivity analyses. No significant differences were found when comparing neural mobilization with other treatment approaches for pain (pooled SMD=−0.67; 95% CI, −2.03 to 0.69; P=0.33), after post hoc sensitivity analysis, and disability (pooled SMD=−0.03; 95% CI, −0.54 to 0.59; P=0.93).

Discussion:
Neural tissue management is superior to minimal intervention for pain relief and reduction of disability in nerve-related chronic MS pain. Existing evidence does not establish superiority of neural mobilization over other forms of intervention in reducing pain and disability in individuals with nerve-related chronic MS pain.
Does Topical Lidocaine Reduce the Pain Associated With the Insertion of Nasal Continuous Positive Airway Pressure Prongs in Preterm Infants?
Authors: Soliman Hasnaa , Elsharkawy Ashraf , Abdel-Hady Hesham 
Published: December 2015

Objective:
To evaluate the efficacy of topical lidocaine 2% gel in reducing the pain associated with the insertion of nasal continuous positive airway pressure (nCPAP) prongs in preterm infants.

Materials and Methods:
A pilot randomized controlled trial. Sixty preterm infants, categorized into lidocaine (n=30) and control groups (n=30). The primary outcome was Premature Infant Pain Profile (PIPP) score, secondary outcomes included salivary cortisol, presence of cry, the duration of first cry, and adverse effects of lidocaine.

Results:
There were no statistically significant differences between lidocaine and control groups regarding PIPP scores (mean±SD: 7.2±2.3 vs. 9.3±3.0, respectively, P=0.086). None of the infants in the lidocaine group had severe pain defined as a PIPP score>12, compared with 3 (10%) infants in the control group (P=0.056). Salivary cortisol concentrations were not significantly different between the lidocaine and control groups (mean±SD: 2.57±1.79 vs. 4.82±1.61 μg/dL, respectively, P=0.11). Standardized effect sizes for topical lidocaine were medium to large for reduction in PIPP scores and large for reduction in salivary cortisol (Cohen d=−0.78 and −1.32, respectively). No adverse effects were reported in infants receiving lidocaine.

Discussion:
Our data suggest that topical lidocaine did not reduce the pain associated with the insertion of nCPAP prongs in preterm infants. However, the trends for lower PIPP scores in the lidocaine group and the effect sizes for lidocaine on PIPP scores and salivary cortisol were large enough so that a large-scale randomized clinical trial is warranted to confirm or refute our results. Such a study should compare 2 or more active pain interventions during nCPAP application, rather than evaluating a single intervention versus placebo or no treatment.
Duloxetine in Painful Diabetic Neuropathy
Authors: Hossain Sultana Mehbuba , Hussain Sultana Monira , Ekram A.R.M.S. 
Published: December 2015

Objective:
To systematically review the evidence for duloxetine in the management of painful diabetic neuropathy (PDN).

Methods:
Electronic searches of Medline and PubMed were performed from 2005 till October 2015 using medical subject headings and free-text words. Two independent reviewers extracted the data and assessed the methodological quality of the selected studies.

Results:
Twenty-three studies met our inclusion criteria and 8 were considered of high quality and were included to this review. Because of heterogeneity of the studies included in this review, statistical pooling of the data was not possible. We found good evidence for use of duloxetine in PDN over placebo and pregabalin but there was no benefit of duloxetine over amitriptyline.

Conclusions:
Duloxetine has a beneficial effect over placebo. Nevertheless, the evidence of superiority of duloxetine over pregabalin and amitriptyline should be explored further as there was only 1 trial for each category. Provided majority of the PDN patients share cardiovascular complications, use of duloxetine will be a good option for treating pain associated with PDN over amitriptyline. Future randomized controlled trials should be designed keeping this in mind.
Central Poststroke Pain Can Occur With Normal Sensation
Authors: Kumar Ajit , Bhoi Sanjeev K. , Kalita Jayantee , Misra Usha K. 
Published: December 2015

Objective:
In view of the paucity of studies on central poststroke pain (CPSP), in this hospital-based prospective study, we evaluated the frequency, the spectrum, imaging, and quantitative sensory testing in a cohort of stroke patients with CPSP.

Methods:
Stroke patients who developed CPSP at onset or during follow-up were included. Patients were subjected to clinical evaluation and sensory testing. The severity of stroke was defined by the Modified Rankin Scale and disability by the Barthel Index. Quantitative sensory testing included monofilament testing and evaluation for static and dynamic mechanical allodynia, punctuate hyperalgesia, temporal summation, cold allodynia, and cold hyperalgesia. Sleep, anxiety, and depression were also evaluated. Patients were treated with pregabalin 150 to 600 mg/d and good response was defined as >50% improvement in the VAS score. CPSP symptoms were correlated with demographic information, sensory findings, and imaging findings.

Results:
A total of 319 patients with stroke were evaluated. CPSP occurred in 66 (20.7%) of them. The median age of the CPSP patients was 55 years (range, 25 to 80 y). About 31.8% patients were female. The onset, the duration, and the distribution of pain were variable. The severity of symptoms did not correlate with demographic variables and the site of lesion. Spinothalamic sensations were normal in 42.3% patients. On treatment with pregabalin (150 to 600 mg), half of the patients had a good response.

Discussion:
CPSP was present in 20.7% of the stroke patients. Spinothalamic tract dysfunction may not be necessary for the development of CPSP, and it can also be seen with normal spinothalamic sensation. The location of the stroke, its type and quality, and the severity of CPSP were not related.
A Systematic Review of Knowledge Translation (KT) in Pediatric Pain
Authors: Gagnon Michelle M. , Hadjistavropoulos Thomas , Hampton Amy J. D. , Stinson Jennifer 
Published: December 2015

Objectives:Pain is inadequately managed in pediatric populations across health care settings. Although training programs to improve health care provider knowledge and skills have been developed and evaluated, clinical practices have not always kept pace with advancing knowledge. Consequently, the goal of this review was to systematically examine the pediatric pain literature of knowledge translation (KT) programs targeting health care providers.Materials and Methods:Systematic searches of PubMed, Web of Science, CINAHL, and PsycINFO were undertaken. KT initiatives directed toward health care providers and in which the primary focus was on pediatric pain were included. Primary outcomes, intervention characteristics, and risk of bias were examined across studies. Study outcomes were conceptually organized and a narrative synthesis of results was conducted.Results:A total of 15,191 abstracts were screened for inclusion with 98 articles retained on the basis of predetermined criteria. Across studies, KT approaches varied widely in format and focus. Knowledge-level changes and self-reported increases in comfort or confidence in skills/knowledge were consistently achieved. Practice-level changes were achieved in many areas with varying success. Design and reporting issues were identified in the majority of studies. Examination of patient-related outcomes and of the long-term impact of pediatric pain KT programs was limited across studies.Discussion:KT programs vary in quality and impact. Although several successful programs have been developed, many studies include a high risk of bias due to study quality. Evidence-based KT program implementation and a focus on sustainability of outcomes must be given greater consideration in the field of pediatric pain.