Resolvin inflammation with pain

Background: Inflammation and pain coexist in conditions such as arthritis, inflammatory bowel disease, and lower back pain. The drugs currently used to treat the combination of inflammation and pain all have disadvantages. Thus, new drugs and new approaches are needed to treat inflammation with pain. The resolvins are considered to be part of the natural resolving mechanism for inflammation, and have been shown to prevent inflammation in animal models. Objectives/methods: To evaluate a paper suggesting that the resolvins RvE1 and RvD1 attenuate inflammatory pain in animal models. Results: RvE1 has been shown to attenuate inflammation and, to a lesser extent, pain in animal models. Limited results are presented of the effectiveness of RvD1 against inflammatory pain. Conclusion: Drugs that mimic or potentiate the effects of the resolvins may be useful for the treatment of some inflammation with pain.

Oxycodone or oxycodone plus paracetamol for acute postoperative pain in adults

In this short communication we wanted to find out what is the analgesic effect of single dose oral oxycodone, with or without the addition of paracetamol, for adults with postoperative pain? Oxycodone at doses of 5mg and above is an effective analgesia for patients with moderate to severe postoperative pain. The efficacy of oxycodone is increased with the addition of paracetamol. The use of oxycodone 10mg plus paracetamol 625mg can be considered for use in the pain relief protocol in post-operative settings. Clinicians should consider a range of factors before prescribing or administering oxycodone for acute post-operative pain, including but not limited to, individual patient clinical profile, adverse effects, cost and patient preference.

Differences in Treatment and Management of Indigenous and Non-Indigenous Patients Presenting with Chest Pain: Results of the Heart Protection Partnership (HPP) Study

BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.

Automatically detecting pain in video through facial action units

In a clinical setting, pain is reported either through patient self-report or via an observer. Such measures are problematic as they are: 1) subjective, and 2) give no specific timing information. Coding pain as a series of facial action units (AUs) can avoid these issues as it can be used to gain an objective measure of pain on a frame-by-frame basis. Using video data from patients with shoulder injuries, in this paper, we describe an active appearance model (AAM)-based system that can automatically detect the frames in video in which a patient is in pain. This pain data set highlights the many challenges associated with spontaneous emotion detection, particularly that of expression and head movement due to the patient's reaction to pain. In this paper, we show that the AAM can deal with these movements and can achieve significant improvements in both the AU and pain detection performance compared to the current-state-of-the-art approaches which utilize similarity-normalized appearance features only.

Moving tele-monitoring and tele-treatment from promise to practice : a business model approach for a chronic lower back pain application

The availability of new information and communication technologies creates opportunities for new, mobile tele-health services. While many promising tele-health projects deliver working R&D prototypes, they often do not result in actual deployment. We aim to identify critical issues than can increase our understanding and enhance the viability of the mobile tele-health services beyond the R&D phase by developing a business model. The present study describes the systematic development and evaluation of a service-oriented business model for tele-monitoring and -treatment of chronic lower back pain patients based on a mobile technology prototype. We address challenges of multi-sector collaboration and disruptive innovation.

When does pain and distress relief hastening death become killing?

This paper discusses the question of when pain and distress relief known to hasten death would cross the line between permissible conduct and killing. The issue is discussed in the context of organ donation after cardiac death, and considers the administration of analgesics, sedatives, and the controversial use of paralysing agents in the provision and withdrawal of ventilation.

Improving posture and decreasing pain with novel shoe insoles

A single subject longevity study is presented as a case study for the Medical Device Partnering Program (MDPP). The MDPP supports the development of cutting-edge medical devices and assistive technologies, through unique collaborations between researchers, industry, clinical end-users and government. The study aimed to identify what effect the innersole has on specific muscles that may influence stability and whether the innersole had any influence on gait. Three tests were conducted; a standard gait test, dynamic balance test and a standing balance test. Results from the kinematic analysis showed reduced variability in post testing results when compared to pre testing results. Reductions in muscle activation levels were also found across all tests. Further testing with a larger sample size is required to determine if these effects are due to the innersole.

A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study

Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods: This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279. Findings: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11•8%) patients had a major adverse cardiac event. The ADP classified 352 (9•8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0•9%) of these patients, giving the ADP a sensitivity of 99•3% (95% CI 97•9–99•8), a negative predictive value of 99•1% (97•3–99•8), and a specificity of 11•0% (10•0–12•2). Interpretation: This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.