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Journal Cover   British Journal of Pain
  [11 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2049-4637 - ISSN (Online) 2049-4645
   Published by Sage Publications Homepage  [819 journals]
  • Editorial
    • Authors: Cox; F.
      Pages: 77 - 77
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463715578337
      Issue No: Vol. 9, No. 2 (2015)
  • Epidural analgesia provides effective pain relief in patients undergoing
           open liver surgery
    • Authors: Ganapathi, S; Roberts, G, Mogford, S, Bahlmann, B, Ateleanu, B, Kumar, N.
      Pages: 78 - 85
      Abstract: Background: Epidural analgesia has been the reference standard for the provision of post-operative pain relief in patients recovering from major upper abdominal operations, including liver resections. However, a failure rate of 20–32% has been reported. Aim: The aim of the study was to analyse the success rates of epidural analgesia and the outcome in patients who underwent liver surgery. Methods: We collected data from a prospectively maintained database of 70 patients who underwent open liver surgery by a bilateral subcostal incision during a period of 20 months (February 2009 to September 2010). Anaesthetic consultants with expertise in anaesthesia for liver surgery performed the epidural catheter placement. A dedicated pain team assessed the post-operative pain scores on moving or coughing using the Verbal Descriptor Scale. The outcome was measured in terms of epidural success rates, pain scores, post-operative chest infection and length of hospital stay. Results: The study group included 43 males and 27 females. The indication for resection was liver secondaries (70%), primary tumours (19%) and benign disease (11%). While major (≥3 segments) and minor resections (≤ 2 segments) were performed in 44% and 47% respectively, 9% of patients were inoperable. Epidural analgesia was successful in 64 patients (91%). Bacterial colonisation of epidural tip was noticed in two patients. However, no neurological complications were encountered. Five patients (7%) had radiologically confirmed chest infection. Four patients (6%) developed wound infection. One patient died due to liver failure following extended right hepatectomy and cholecystectomy for gall bladder cancer. The median length of stay was 6 days (3–27 days). The extent of liver resection (p = 0.026) and post-operative chest infection (p = 0.012) had a significant influence on the length of stay. Conclusion: Our experience shows that epidural analgesia is safe and effective in providing adequate pain relief following open liver surgery.
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463714525140
      Issue No: Vol. 9, No. 2 (2015)
  • The epidemiology of regional and widespread musculoskeletal pain in rural
           versus urban settings in those>=55 years
    • Authors: Docking, R. E; Beasley, M, Steinerowski, A, Jones, E. A, Farmer, J, Macfarlane, G. J, Jones, G. T.
      Pages: 86 - 95
      Abstract: Objectives: To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Methods: Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi2 test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. Results: There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with the reporting of CWP included poor general health, feeling downhearted most of the time and selected measures of social contact. Factors independently associated with CWP included female gender (risk ratio: 1.24; 95% confidence interval (CI): 0.997–1.55), poor self-rated health (risk ratio: 3.50; 95% CI: 1.92–6.39) and low mood (risk ratio: 1.54; 95% CI: 1.07–2.20). Also, having fewer than 10 people to turn to in a crisis was associated with a decrease in the risk of CWP – risk ratio: 0.68 (95% CI: 0.50–0.93) and 0.78 (95% CI: 0.60–1.02) for those with 5–10 and
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463714527438
      Issue No: Vol. 9, No. 2 (2015)
  • Prevalence of chronic non-cancer pain in a UK prison environment
    • Authors: Croft, M; Mayhew, R.
      Pages: 96 - 108
      Abstract: Chronic non-cancer pain (CNCP) is significant global health issue, accounting for a substantial increase in prescription analgesics worldwide, in recent decades. This clinical burden is evident in the UK prison population, where the prevalence of CNCP has never previously been determined. This study, conducted in June/July 2013, used prescribing data and a systematic review of clinical records from two UK prison establishments to derive a figure for point-prevalence of CNCP. Results showed that 20% of the total aggregated prisoner rolls (N = 1944) described CNCP and had been in receipt of treatment with daily analgesia, for a period of at least 3 months prior to observation date. This prevalence of CNCP was related to increasing age group (Spearman’s rank correlation 0.94). Of those on continuous analgesic therapy (CAT), 44% were taking continuous opioid therapy (COT) of any sort. Prisoners with a diagnosis of opioid-type drug dependence (OTDD) were more than twice as likely to complain of CNCP and be on continuous medication for it (odds ratio 2.3). The issues relating to CNCP in prisons are discussed. Further research is recommended, identifying factors influencing CNCP prevalence in prisons, and enabling comparisons to CNCP prevalence in the UK general population.
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463714540895
      Issue No: Vol. 9, No. 2 (2015)
  • Medically Unexplained Symptoms: an acceptable term'
    • Authors: Marks, E. M; Hunter, M. S.
      Pages: 109 - 114
      Abstract: Background: The term ‘Medically Unexplained Symptoms’ (MUS) is used by health professionals and researchers to refer to persistent bodily complaints, including pain and discomfort. Aims: This study explores the views held by a lay sample on the clinical terminology used to describe ‘MUS’, to ascertain reasons for particular preferences and whether preferences differ between individuals who experience more somatic symptoms. Design and methods: A sample (n = 844) of healthy adults completed an online survey, which included a questionnaire measuring somatic symptoms (Patient Health Questionnaire-15 (PHQ-15)) and a question about their preferences for terminology used to describe MUS. Results: Of 844 participants, 698 offered their preferences for terminology. The most popular terms were ‘Persistent Physical Symptoms’ (20%) and ‘Functional Symptoms’ (17%). ‘MUS’ (15%), ‘Body Distress Disorder’ (13%) and ‘Complex Physical Symptoms’ (5%) were less popular. And 24% indicated no preference, but high PHQ-15 scorers were more likely to express preferences than low scorers. Conclusion: Persistent Physical Symptoms and Functional Symptoms are more acceptable to this sample of healthy adults than the more commonly used term ‘MUS’.
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463714535372
      Issue No: Vol. 9, No. 2 (2015)
  • Is intramuscular morphine satisfying frontline medical personnels'
           requirement for battlefield analgesia in Helmand Province,
           Afghanistan' A questionnaire study
    • Authors: Blankenstein, T. N; Gibson, L. M, Claydon, M. A.
      Pages: 115 - 121
      Abstract: Background: All deployed British Army personnel carry intramuscular (IM) morphine auto-injectors to treat battlefield casualties. No other nation supplies parenteral opiate analgesia on individual issue. Studies highlight this agent’s inefficacy and safety issues, but are limited by a relative lack of inclusion of frontline personnel. We aimed to determine the opinions of frontline medical personnel on current battlefield analgesia. Methods: We surveyed 88 British Army frontline medical personnel (medical officers (n = 12), nurses (n = 7), combat medical technicians (CMTs) (n = 67), paramedics (n = 1) and health-care assistants (n = 1)) upon completion of a six-month deployment (September 2011 to April 2012) to Helmand Province, Afghanistan, using Likert scale questions on the efficacy of battlefield analgesia, complications of IM morphine, safety of morphine auto-injectors and its suitability for treating child casualties. Results: A total of 88/88 questionnaires were returned. Of these, 61/88 had treated casualties on the battlefield, 26/86 agreed that current battlefield analgesia is effective, 80/87 agreed that a more potent analgesic with a faster onset than IM morphine is desirable in the first hour following injury, 47/65 CMTs agreed that they can manage complications of current battlefield analgesia and 53/86 respondents correctly disagreed that current battlefield analgesia is suitable for child casualties. The potential for accidental self-injection was reported. Conclusions: A more potent, faster onset analgesic than IM morphine is desirable in the first hour following injury. Pre-deployment training should emphasise management of complications of opiate analgesics and treatment of child casualties. Oral transmucosal fentanyl citrate is now being issued to all frontline medical personnel. IM morphine will remain on individual issue to all deployed soldiers for environments where an oral agent is not suitable, for example, chemical, biological, radiological and nuclear warfare. Summary points
      Frontline medical personnel agree that a more potent, faster onset analgesic than IM morphine is desirable in the first hour following injury.
      The two most desirable features of the ideal analgesic were ranked as rapid onset of action, and when fully onset produces a high degree of pain relief.
      Oral transmucosal fentanyl citrate (OTFC) has now been issued to all frontline medical personnel as an adjunct to IM morphine.
      IM morphine will remain on individual issue for situations where parenteral analgesia is required.
      Consideration should be given to individual issue of OTFC to all deployed personnel in the future.
      Pre-deployment training should emphasise management of complications of opiate analgesics and treatment of child casualties.
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463714535563
      Issue No: Vol. 9, No. 2 (2015)
  • Establishing the characteristics for patients with chronic Complex
           Regional Pain Syndrome: the value of the CRPS-UK Registry
    • Authors: Shenker, N; Goebel, A, Rockett, M, Batchelor, J, Jones, G. T, Parker, R, de C Williams, A. C, McCabe, C.
      Pages: 122 - 128
      Abstract: Objective: The long-term prognosis of patients with Complex Regional Pain Syndrome (CRPS) is unknown with no reported prospective studies from the United Kingdom longer than 18 months. The CRPS-UK Network aims to study this by use of a Registry. The aims of this article are, to outline the CRPS-UK Registry, assess the validity of the data and to describe the characteristics of a sample of the UK CRPS population. Methods: A web-based CRPS-UK Registry was developed and made accessible to centres experienced in diagnosing and managing patients with CRPS. Pragmatic annual follow-up questions were agreed. Results: Up until July 2013, the Registry has recruited 240 patients. A blinded, validation study of 20 consecutive patients from two centres (10 each) demonstrated 95.6% completion and 99.4% accuracy of a random sample of the recorded data. These patients had chronic disease (median duration: 29 months); 72.5% were female (2.6:1), with a mean age at symptoms onset of 43 years, and were left-handed more than expected (21.8% versus 10% in the general population). Patients reported a delayed diagnosis, with the median time between symptom onset and diagnosis of 6 months. In all, 30 patients (12.5%) had multiple limb involvement and (83.3%) had a contiguous spread of CRPS. Conclusion: CRPS-UK Registry is a validated method for actively recruiting well-characterised patients with CRPS to provide further information on the long-term outcome.
      PubDate: 2015-04-14T03:21:43-07:00
      DOI: 10.1177/2049463714541423
      Issue No: Vol. 9, No. 2 (2015)
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