Investigation of pain requires measurements of nociceptive sensitivity and other pain-related behaviors. Recent studies have indicated the superiority of gait analysis over traditional evaluations (e.g., skin sensitivity and sciatic function index [SFI]) in detecting subtle improvements and deteriorations in animal models. Here, pain-related gait parameters, whose criteria include (1) alteration in pain models, (2) correlation with nociceptive threshold, and (3) normalization by analgesics, were identified in representative models of neuropathic pain (spared nerve injury: coordination data) and inflammatory pain (intraplantar complete Freund's adjuvant: both coordination and intensity data) in the DigiGait™ and CatWalk™ systems. DigiGait™ had advantages in fixed speed (controlled by treadmill) and dynamic SFI, while CatWalk™ excelled in intrinsic velocity, intensity data, and high-quality 3D images. Insights into the applicability of each system may provide guidance for selecting the appropriate gait imaging system for different animal models and optimization for future pain research.
Analgesics ; administration & dosage ; Animals ; Freund's Adjuvant ; administration & dosage ; Gait ; drug effects ; Gait Analysis ; methods ; Image Processing, Computer-Assisted ; Inflammation ; chemically induced ; Male ; Neuralgia ; physiopathology ; prevention & control ; Pain ; etiology ; physiopathology ; prevention & control ; Rats, Sprague-Dawley

Acute Pain ; etiology ; prevention & control ; Chronic Pain ; etiology ; prevention & control ; Humans ; Lung Neoplasms ; surgery ; Pneumonectomy ; adverse effects ; methods ; Thoracic Surgery, Video-Assisted

ObjectiveTo evaluate the analgesic effect of intrarectal local anesthesia (IRLA) versus that of periprostatic nerve block anesthesia (PPNB) in initial transrectal ultrasound-guided prostate biopsy (TRUS-PB) for patients with different prostate volumes (PV).

METHODSA total of 253 patients undergoing initial TRUS-PB in our hospital from January 2014 to November 2017 were divided into three PV groups (<50 ml, 50－100 ml, and >100 ml), each again randomized into three subgroups (control, IRLA, and PPNB) with the random number table method. The pain during the procedure was assessed based on the Visual Analogue Scale (VAS) scores and the blind method was used by the biopsy operator, VAS valuator and data analyst.

RESULTSAmong the patients with PV <50 ml, the VAS scores in the blank control, IRLA, and PPNB subgroups were 4.39±0.87, 3.51±0.84 and 3.43±1.07, respectively, remarkably higher in the control than in the IRLA and PPNB groups (P<0.05), but with no statistically significant differences between the latter two (P>0.05). Among those with PV of 50－100 ml, the VAS scores in the three subgroups were 4.50±1.05, 4.38±1.13 and 3.38±1.44, respectively, markedly higher in the control and IRLA than in the PPNB group (P<0.05), but with no statistically significant differences between the former two groups (P>0.05). Among those with PV >100 ml, the VAS scores in the three subgroups were 5.19±1.05, 5.00±1.25 and 4.19±0.91, respectively, remarkably higher in the former two groups than in the latter (P<0.05), but with no statistically significant differences between the former two groups (P>0.05).

CONCLUSIONSEither IRLA or PPNB can be recommended for initial TRUS-PB in patients with PV <50 ml, PPNB for those with PV of 50－100 ml, and PPNB with other painkillers for those with PV >100 ml.

Administration, Rectal ; Aged ; Anesthesia, Local ; methods ; Anesthetics, Local ; administration & dosage ; Biopsy ; Humans ; Male ; Nerve Block ; methods ; Pain Measurement ; Pain, Procedural ; etiology ; prevention & control ; Prospective Studies ; Prostate ; pathology

Postoperative internal hernia is a rare clinical complication which often occurs after digestive tract reconstruction. Roux-en-Y anastomosis is a common type of digestive tract reconstruction. Internal hernia after Roux-en-Y reconstruction, which occurs mainly in the mesenteric defect caused by incomplete closure of mesenteric gaps in the process of digestive tract reconstruction, is systematically called, in our research, as mesenteric internal hernia after Roux-en-Y reconstruction. Such internal hernia can be divided, according to the different structures of mesentric defect, into 3 types: the type of mesenteric defect at the jejunojejunostomy (J type), the type of Petersen's defect (P type), and the type of mesenteric defect in the transverse mesocolon (M type). Because of huge differences in the number of cases and follow-up time among existing research reports, the morbidity of internal hernia after LRYGB fluctuates wildly between 0.2% and 9.0%. Delayed diagnosis and treatment of mesenteric internal hernia after Roux- en-Y reconstruction may result in disastrous consequences such as intestinal necrosis. Clinical manifestations of internal hernia vary from person to person: some, in mild cases, may have no symptoms at all while others in severe cases may experience acute intestinal obstruction. Despite the difference, one common manifestation of internal hernia is abdominal pain. Surgical treatment should be recommended for those diagnosed as internal hernia. A safer and more feasible way to conduct the manual reduction of the incarcerated hernia is to start from the distal normal empty bowel and trace back to the hernia ring mouth, enabling a faster identification of hernia ring and its track. The prevention of mesenteric internal hernia after Roux-en-Y reconstruction is related to the initial surgical approach and the technique of mesenteric closure. Significant controversy remains on whether or not the mesenteric defect should be closed in laparoscopic Roux-en-Y anastomosis. This article is to review the reports and researches on internal hernia resulting from the mesenteric defect after Roux-en-Y digestive tract reconstruction in recent years, so as to promote understanding and attention on this disease. And more active preventive measures are strongly suggested to be taken in operations where digestive tract reconstruction is involved.
Abdominal Pain ; diagnosis ; Anastomosis, Roux-en-Y ; adverse effects ; methods ; Gastric Bypass ; adverse effects ; methods ; Hernia, Abdominal ; diagnosis ; etiology ; prevention & control ; surgery ; Humans ; Intestinal Obstruction ; etiology ; Intestine, Small ; pathology ; surgery ; Laparoscopy ; adverse effects ; methods ; Mesentery ; pathology ; surgery ; Mesocolon ; pathology ; surgery ; Postoperative Complications ; prevention & control ; surgery ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies

Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA I-II adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 mL (P100 group), 250 mL (P250 group), 500 mL (P500 group), 0.9% saline 500 mL (N500 group) or Gelofusine 500 mL (G500 group) was completed within 30 min, respectively, Propofol (0.5 mg/kg, 1%) was injected at a rate of 0.5 mL/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively (P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups (P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group (62.5%) (N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group (P<0.05) and G500 group (P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 mL before propofol injection is effective in alleviating propofol-induced pain.
Adolescent ; Adult ; Aged ; Electrolytes ; administration & dosage ; therapeutic use ; Female ; Humans ; Injections, Intravenous ; adverse effects ; methods ; Male ; Middle Aged ; Pain ; drug therapy ; etiology ; prevention & control ; Plasma Substitutes ; administration & dosage ; therapeutic use ; Polygeline ; administration & dosage ; therapeutic use ; Propofol ; administration & dosage ; adverse effects

PURPOSE: To investigate predictors of progression to castration-resistant prostate cancer (CRPC) and cancer-specific mortality (CSM) in patients with metastatic prostate cancer (mPCa). MATERIALS AND METHODS: A retrospective analysis was performed on 440 consecutive treatment-naive patients initially diagnosed with mPCa between August 2000 and June 2012. Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed. Cox-proportional hazards regression analyses were used to evaluate survivals and predictive variables of men with bone metastasis stratified according to the presence of pain, compared to men with visceral metastasis. RESULTS: Metastases were most often found in bone (75.4%), followed by lung (16.3%) and liver (8.3%) tissues. Bone metastasis, pain, and high BMI were associated with increased risks of progression to CRPC, and bone metastasis, pain, PSA nadir, and ECOG PS> or =1 were significant predictors of CSM. During the median follow-up of 32.0 (interquartile range 14.7-55.9) months, patients with bone metastasis with pain and patients with both bone and visceral metastases showed the worst median progression to CRPC-free and cancer-specific survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals. CONCLUSION: Metastatic spread and pain patterns confer different prognosis in patients with mPCa. Bone may serve as a crucial microenvironment in the development of CRPC and disease progression.
Aged ; Bone Neoplasms/secondary ; *Disease Progression ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Metastasis ; Pain/diagnosis/etiology/prevention & control ; Pain Measurement ; Prognosis ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/mortality/*pathology ; Prostatic Neoplasms, Castration-Resistant/mortality/*pathology ; Retrospective Studies ; Risk ; Treatment Outcome

PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.
Adult ; Analgesia/*methods ; Analgesics/*therapeutic use ; Arthroscopy/*adverse effects ; Female ; Humans ; Hypnotics and Sedatives/*therapeutic use ; Male ; Middle Aged ; Pain Management ; Pain Measurement ; Pain, Postoperative/drug therapy/etiology/*prevention & control ; Postoperative Period ; Prospective Studies ; Pyridines/*therapeutic use ; Rotator Cuff/injuries/*surgery ; Sleep/drug effects ; Treatment Outcome ; Visual Analog Scale

PURPOSE: Transrectal ultrasound (TRUS)-guided prostate biopsy is the most useful technique for the diagnosis of prostate cancer; however, many patients describe the procedure as uncomfortable and painful. We investigated the effect of the patient's position on pain scales during TRUS-guided prostate biopsy. MATERIALS AND METHODS: Between July 2012 and June 2013, a total of 128 consecutive patients who underwent TRUS-guided prostate biopsy were included in this study. Seventy patients underwent the procedure in the lithotomy position performed by a urologist and the other patients (n=58) underwent the procedure in the left lateral decubitus (LLD) position performed by a radiologist. Pain was assessed by using visual analogue scale (VAS) scores from 0 to 10. Using a linear regression model, we analyzed the correlation between pain scale score and clinical variables with a focus on patient position. RESULTS: No significant differences related to age, body mass index, prostate volume, prostate-specific antigen (PSA), hematuria, pyuria, International Prostate Symptom Score, or the cancer detection rate were observed between the lithotomy and the LLD groups. In the correlation analysis, VAS score showed a significant correlation with diabetes mellitus, PSA level, and lithotomy position (p<0.05). In the multiple linear regression model, VAS score showed a significant correlation with lithotomy position (beta=-0.772, p=0.003) and diabetes mellitus (beta=-0.803, p=0.033). CONCLUSIONS: We suggest that the lithotomy position may be the proper way to reduce pain during TRUS-guided prostate biopsy.
Aged ; Biopsy, Needle/*adverse effects/methods ; Humans ; Male ; Middle Aged ; Pain/etiology/*prevention & control ; Pain Measurement/methods ; Patient Positioning/*methods ; Posture/physiology ; Prostatic Neoplasms/*pathology ; Retrospective Studies ; Ultrasonography, Interventional/methods

BACKGROUND/AIMS: Postprandial symptoms of fullness and abdominal discomfort are common after fatty meals. Gastric lipases hydrolyze 10% to 20% of dietary triglycerides during the stomach trituration period of digestion. The aim of this study was to evaluate the effects of acid-resistant lipase on upper gastrointestinal symptoms, including fullness and bloating, as well as on gastric myoelectrical activity after healthy subjects ingested a high-fat, liquid meal. METHODS: This study utilized a double-blind, placebo-controlled, crossover design with 16 healthy volunteers who ingested either a capsule containing 280 mg of acid-resistant lipase or a placebo immediately before a fatty meal (355 calories, 55% fat). Participants rated their stomach fullness, bloating, and nausea before and at timed intervals for 60 minutes after the meal. Electrogastrograms were obtained to assess the gastric myoelectrical activity. RESULTS: Stomach fullness, bloating, and nausea increased significantly 10 minutes after ingestion of the fatty meal (p<0.01), whereas normal gastric myoelectrical activity decreased and tachygastria increased (p<0.05). With lipase, reports of stomach fullness were significantly lower compared with placebo (p<0.05), but no effect on gastric myoelectrical activity or other upper gastrointestinal symptoms was observed. CONCLUSIONS: The high-fat meal induced transient fullness, bloating, nausea, and tachygastria in healthy individuals, consistent with post-prandial distress syndrome. Acid-resistant lipase supplementation significantly decreased stomach fullness.
Abdominal Pain/etiology/psychology ; Adult ; Cross-Over Studies ; Diet, High-Fat/*adverse effects/psychology ; *Dietary Supplements ; Double-Blind Method ; Dyspepsia/etiology/*prevention & control/psychology ; Female ; Gastrointestinal Motility/drug effects/physiology ; Healthy Volunteers ; Humans ; Lipase/*administration & dosage ; Male ; Meals ; Middle Aged ; Myoelectric Complex, Migrating ; Nausea/etiology/psychology ; Postprandial Period ; Stomach/*drug effects/physiology ; Young Adult

INTRODUCTIONThere have been intermittent reports of peroneal neuropathy (PN) occurring after liver transplantation. Although PN may not be viewed as a serious complication by liver transplant (LT) recipients who require the transplant for survival, PN can significantly reduce quality of life. The incidence of PN appears to have increased after the use of gel pads was introduced. These gel pads, which are placed under patients' knees during surgery, are used to reduce lower back strain and prevent contact between the peroneal nerve at the fibular head and the hard surface of the operating table. The aim of the present study was to investigate the association, if any, between the use of gel pads and the incidence of PN.

METHODSThe medical records of 261 adult LT recipients were retrospectively reviewed. The recipients were divided into gel pad (n = 167) and non-gel pad (n = 94) groups. The incidence and possible risk factors of PN were compared between the two groups.

RESULTSThe overall incidence of PN was 8.0% (21/261). The occurrence of PN was significantly higher in the gel pad group than in the non-gel pad group (10.8% vs. 3.2%; p < 0.05). Other possible risk factors were comparable between the two patient groups.

CONCLUSIONAs the use of gel pads may increase the incidence of PN, we recommend against the use of gel pads under the knees of LT recipients.

Adult ; Female ; Gels ; Humans ; Incidence ; Liver Failure ; complications ; surgery ; Liver Transplantation ; adverse effects ; Low Back Pain ; prevention & control ; Male ; Middle Aged ; Peroneal Neuropathies ; etiology ; prevention & control ; Postoperative Complications ; prevention & control ; Protective Devices ; Quality of Life ; Retrospective Studies ; Risk Factors ; Treatment Outcome