Chronic Pain and the Brain Intractable Pain: In one study, the reported prevalence of chronic pain in the general population was as high as In this article, I have reviewed 6 papers published recently that provide important information in answering questions that general practitioners may be faced with when seeing patients with neuropathic pain.
Suturing plays no significant role in achieving hemostasis and should be used only when needed. Continued warfarin treatment; no sutures placed. Continued warfarin treatment; sutures placed Carter and Goss20 Group 1: Patients continued warfarin and used 4.
Patients continued warfarin; sockets were irrigated with 4. Both tranexamic acid mouthwash and AFG are similarly effective in preventing postoperative bleeding. The routine discontinuation of warfarin before dental extractions should be reconsidered. Patients continued warfarin; after the extraction, sockets were dressed with Surgicel, a resorbable oxycellulose dressing Bleeding on day 1 after extractions numbers too small to test for significance of difference: The authors concluded that patients taking warfarin can safely undergo dental extractions without any change of regimen if an effective local hemostatic agent, such as Histoacryl glue, is used.
The first study20 randomly assigned patients to a 5-day or a 2-day regimen of 4. Minor bleeding was observed in only 3 patients and there were no significant differences between the groups. The second study21 compared a 7-day regimen of 4.
Minor bleeds were observed in only 2 patients in the autologous fibrin glue group, with no significant differences among the groups. Both studies concluded that the compared interventions were similarly effective.
After extraction, sockets were dressed with 1 of the hemostatic agents and then sutured with softgut. Bleeding was observed in 3 patients in total: The low bleeding rate did not allow statistical testing of the difference. The authors concluded that both treatments were equally effective in preventing bleeding after dental extractions.
Two patients in the warfarin continuation group required a hospital visit to stop the bleeding. The study by Al-Mubarak et al. The observed bleeding rate on the first postoperative day was slightly but not significantly higher in the 2 groups that continued warfarin compared with the groups that discontinued warfarin treatment.
Bleeding rates significantly diminished by day 7 with no significant differences among the groups on any of the postoperative days. Suturing did not play any role, and wound healing was similar across the groups. All bleeding events were described as "of the mild transient type.
Although these studies rated highly in terms of quality of evidence, we identified some risks of bias.
The most significant source of potential bias was the lack of blinding. The role of patient blinding was crucial in these studies, as bleeding was first reported by patients and then reviewed by treating doctors, if necessary.
Although blinding patients to duration of tranexamic acid mouthwash use or to discontinuation of warfarin may seem to be impractical, it is still possible to achieve adequate blinding by using a placebo treatment.
Only 1 study reported blinding of outcome assessors,17 and 1 reported partial blinding of personnel. Regular INR monitoring is part of the standard care for patients taking warfarin.
INR was also actively monitored postoperatively. Therefore, our findings are applicable only to patients whose INR is within the therapeutic range before dental extraction.A review of the literature was conducted to identify best practices regarding pain management in adolescents with sickle cell anemia.
Key words such as pain, pain management, adolescent sickle cell anemia, and acute sickle cell pain were entered into databases to reveal qualitative and quantitative studies from to the present.
i LITERATURE REVIEW: MODELS OF CARE FOR PAIN MANAGEMENT FINAL REPORT Jane Conway and Isabel Higgins October Mercury is a toxic heavy metal which is widely dispersed in nature. Most human exposure results from fish consumption or dental amalgam. Mercury occurs in several chemical forms, with complex pharmacokinetics.
Mercury is capable of inducing a wide range of clinical presentations. Diagnosis of mercury toxicity can be challenging but can be obtained with reasonable reliability.
INTRODUCTION. Opioids are widely used for treatment of pain in patients with cancer because of their safety, multiple routes of administration, ease of titration, reliability, and effectiveness for all types of pain (ie, somatic, visceral, neuropathic).
Oct 14, · Rhabdomyolysis (literally, “dissolution of skeletal muscle”) is a syndrome caused by injury to skeletal muscle and involves leakage of large quantities of potentially toxic intracellular contents into plasma. First described in the victims of crush injury during World War II, it is a final pathway of diverse processes and insults.
Clinical Guidelines. The American Academy of Pain Medicine and its board of directors has researched and approved certain evidence-based clinical practice guidelines for the use in treating pain patients.