1
|
Hayes M, Hutchinson A, Kerr D. Gender-based differences in assessment and management of acute abdominal pain in the emergency department: A retrospective audit. Australas Emerg Care 2023; 26:290-295. [PMID: 36914504 DOI: 10.1016/j.auec.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Previous research has identified gender-based differences in acute pain management in the emergency department [ED]. The aim of this study was to compare pharmacological management of acute abdominal pain in the ED by gender. METHODS A retrospective chart audit was conducted at one private metropolitan ED including adult patients (18-80 years) who presented with acute abdominal pain in 2019. Exclusion criteria included: pregnancy, repeat presentation within the study period, pain-free at initial medical review or documented refusal of analgesia, and oligo-analgesia. Comparisons by gender included: (1) analgesia type and (2) time to analgesia. Bivariate analysis was undertaken using SPSS. RESULTS There were 192 participants: 61 (31.6 %) men and 131 (67.9 %) women. Men were more likely to get combined opioid and non-opioid medication as first line analgesia (men: 26.2 % n = 16; women: 14.5 % n = 19, p = .049). Median time from ED presentation to analgesia was 80 min for men (IQR: 60) versus 94 min for women (IQR: 58), (p = .119). Women (25.2 % n = 33) were more likely to receive their first analgesic after 90 min from ED presentation compared to men versus men (11.5 %, n = 7 p = .029). In addition, women waited longer before receiving second analgesia (women: 94, men: 30 min, p = .032). CONCLUSION Findings confirm there are differences in pharmacological management of acute abdominal pain in the ED. Larger studies are required to further explore differences observed in this study.
Collapse
Affiliation(s)
- Megan Hayes
- Cabrini Health, The Patricia Peck Education and Research Precinct, Australia; Epworth HealthCare, Emergency Department, Richmond, Victoria, Australia.
| | - Ana Hutchinson
- Deakin University, Institute of Health Transformation, Centre for Quality and Safety Research, Epworth HealthCare, Deakin University Partnership, Australia; Deakin University, School of Nursing & Midwifery, Burwood, Victoria, Australia.
| | - Debra Kerr
- Deakin University, School of Nursing & Midwifery, Burwood, Victoria, Australia; Deakin University, Institute of Health Transformation, Centre for Quality and Safety Research, Australia.
| |
Collapse
|
2
|
Silva AJ, de Sousa RJ, Fernandes FA, Ptak M, Dymek M, Parente MP. Improvement and validation of a female finite element model of the cervical spine. J Mech Behav Biomed Mater 2023; 142:105797. [PMID: 37058864 DOI: 10.1016/j.jmbbm.2023.105797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/20/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
Although the cervical spine supports and controls the kinematics of the head, it is vulnerable to injuries during mechanical loading. Severe injuries often result in damage to the spinal cord, leading to significant ramifications. The role of gender in determining the outcome of such injuries has been established as significant. In order to better understand the essential mechanics and develop treatments or preventative measures, various forms of research have been conducted. Computational modelling is one of the most useful and extensively utilised methods, as it provides information that would otherwise be difficult to obtain. As such, the primary goal of this research is to create a new finite element of the female cervical spine that will more accurately represent the group most affected by such injuries. This work is a continuation of a previous study where a model was created from the computer tomography scans of a 46-year-old female. A functioning spinal unit consisting of the C6-C7 segment was simulated as a validation procedure. The experimental data obtained from cadaveric specimens, that assessed the range of motion of different cervical segments in flexion-extension, axial rotation, and lateral bending, was used to validate the reduced model.
Collapse
|
3
|
Hughes JA, Chiu J, Brown NJ, Hills A, Allwood B, Chu K. The documentation of pain intensity and its influences on care in the emergency department. Int Emerg Nurs 2021; 57:101015. [PMID: 34166989 DOI: 10.1016/j.ienj.2021.101015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first analgesic medication (TTA) and ED length of stay (EDLOS) are unknown. METHODS This is a retrospective cross-sectional study to investigate the association between documented evidence of pain intensity scores, TTA and EDLOS in the ED. It also examined the factors associated with the documentation of pain intensity scores. Univariate and multivariable modelling was used on a random sample of presentations. RESULTS There were no statistically significant associations between the documented evidence of pain intensity scores and TTA or EDLOS. Modelling suggests that patients were less likely to have documented evidence of pain intensity scores if they were male, were streamed to the fast-track treatment area, had a lower burden of co-morbidities, or when the general departmental workload was increased. CONCLUSIONS The documentation of pain intensity scores was not associated with TTA or EDLOS. Some demographic, illness and workload factors are associated with the lack of pain intensity score documentation, however, the effect on patients outcomes needs further investigation.
Collapse
Affiliation(s)
- James A Hughes
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia.
| | - Jacqui Chiu
- Facility of Medicine, The University of Queensland, Brisbane, Australia
| | - Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Facility of Medicine, The University of Queensland, Brisbane, Australia
| | - Angela Hills
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Brandon Allwood
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Emergency Department, Mater Public Hospital, Brisbane, Australia
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Facility of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
4
|
Lau T, Hayward J, Vatanpour S, Innes G. Sex-related differences in opioid administration in the emergency department: a population-based study. Emerg Med J 2021; 38:467-473. [PMID: 33853938 DOI: 10.1136/emermed-2020-210215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/16/2021] [Accepted: 03/24/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sex differences in pain experience and expression may influence ED pain management. Our objective was to evaluate the effect of sex on ED opioid administration. METHODS We conducted a multicentre population-based observational cohort study using administrative data from Calgary's four EDs between 2017 and 2018. Eligible patients had a presenting complaint belonging to one of nine pain categories or an arrival pain score >3. We performed multivariable analyses to identify predictors of opioid administration and stratified analyses by age, pain severity and pain category. RESULTS We studied 119 510 patients (mean age 47.4 years; 55.4% female). Opioid administration rates were similar for men and women. After adjusting for age, hospital site, pain category, ED length of stay and pain severity, male sex was not a predictor of opioid treatment (adjusted OR (aOR)=0.93; 95% CI 0.85 to 1.02). However, men were more likely to receive opioids in the categories of trauma (aOR=1.58, 95% CI 1.40 to 1.78), flank pain (aOR=1.24, 95% CI 1.11 to 1.38), headache (aOR=1.18, 95% CI 1.03 to 1.34) and abdominal pain (aOR=1.11, 95% CI 1.08 to 1.18). Pain category appears to be a strong determinant of opioid administration, especially back pain (aOR=6.56, 95% CI 5.99 to 7.19) and flank pain (aOR=6.04, 95% CI 5.48 to 6.65). There was significant variability in opioid provision by ED site (aOR 0.76 to 1.24). CONCLUSIONS This population-based study demonstrated high variability in opioid use across different settings. Overall, men and women had similar likelihood of receiving opioids; however men with trauma, flank pain, headache and abdominal pain were much more likely to receive opioids. ED physicians should self-examine their analgesic practices with respect to possible sex biases, and departments should introduce evidence-based, indication-specific analgesic protocols to reduce practice variability and optimise opioid analgesia.
Collapse
Affiliation(s)
- Torey Lau
- Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jake Hayward
- Emergency Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Shabnam Vatanpour
- Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Grant Innes
- Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
5
|
Linher-Melville K, Shah A, Singh G. Sex differences in neuro(auto)immunity and chronic sciatic nerve pain. Biol Sex Differ 2020; 11:62. [PMID: 33183347 PMCID: PMC7661171 DOI: 10.1186/s13293-020-00339-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/20/2020] [Indexed: 01/13/2023] Open
Abstract
Chronic pain occurs with greater frequency in women, with a parallel sexually dimorphic trend reported in sufferers of many autoimmune diseases. There is a need to continue examining neuro-immune-endocrine crosstalk in the context of sexual dimorphisms in chronic pain. Several phenomena in particular need to be further explored. In patients, autoantibodies to neural antigens have been associated with sensory pathway hyper-excitability, and the role of self-antigens released by damaged nerves remains to be defined. In addition, specific immune cells release pro-nociceptive cytokines that directly influence neural firing, while T lymphocytes activated by specific antigens secrete factors that either support nerve repair or exacerbate the damage. Modulating specific immune cell populations could therefore be a means to promote nerve recovery, with sex-specific outcomes. Understanding biological sex differences that maintain, or fail to maintain, neuroimmune homeostasis may inform the selection of sex-specific treatment regimens, improving chronic pain management by rebalancing neuroimmune feedback. Given the significance of interactions between nerves and immune cells in the generation and maintenance of neuropathic pain, this review focuses on sex differences and possible links with persistent autoimmune activity using sciatica as an example.
Collapse
Affiliation(s)
- Katja Linher-Melville
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Anita Shah
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gurmit Singh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
6
|
African American Young Adults' Pain and Pain Reduction Strategies. Pain Manag Nurs 2020; 21:423-427. [PMID: 32591328 DOI: 10.1016/j.pmn.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Effective acute pain management strategies are important for young adults in order to reduce risk for transition to chronic pain. AIM To describe pain and pain self-management strategies used by African American young adults. DESIGN & SETTING A national online cross-sectional survey design was used. PARTICIPANT/SUBJECTS Ninety-four African Americans Qualtrics panelists ages 18-25 who reported previous experience with acute pain responded. Methods: Respondents completed the Brief Pain Inventory Short Form to describe their pain intensity, pain interference with function, pain self-management, and percent of relief obtained from their self-management. RESULTS African American young adults reported pain primarily in the back (n = 22, 23.4%) and head (n = 19, 20.2%), with moderate pain intensity M = 4.5 (standard deviation [SD] = 1.79) and pain interference with function M = 4.6 (SD = 2.36). African American young adults described their worst pain in the last 24 hours as M = 5.7 (SD = 2.01), least pain as M = 3.4 (SD = 2.41), and average pain as M = 5.1 (SD = 2.09). They reported 61.3% pain relief from self-treatment. A total of 45 (47.9%) reported no pain self-management strategies. CONCLUSIONS African American young adults report moderate levels of pain intensity and pain interference with function. A significant number report no pain self-management strategies. Focused pain assessment and education about efficacious pain self-management strategies, both pharmacological and complementary, could assist young African Americans to reduce their pain and risk of chronic pain in the future.
Collapse
|
7
|
Yu S, Chen C, Pan Y, Kurz MC, Datner E, Hendry PL, Velilla MA, Lewandowski C, Pearson C, Domeier R, McLean SA, Linnstaedt SD. Genes known to escape X chromosome inactivation predict co-morbid chronic musculoskeletal pain and posttraumatic stress symptom development in women following trauma exposure. Am J Med Genet B Neuropsychiatr Genet 2019; 180:415-427. [PMID: 30537437 PMCID: PMC7138464 DOI: 10.1002/ajmg.b.32706] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/28/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022]
Abstract
Co-morbid chronic musculoskeletal pain (CMSP) and posttraumatic stress symptoms (PTSS) are frequent sequelae of motor vehicle collision, are associated with greater disability than either outcome alone, and are more prevalent in women than men. In the current study we assessed for evidence that gene transcripts originating from the X chromosome contribute to sex differences in vulnerability to CMSP and PTSS after motor vehicle collision. Nested samples were drawn from a longitudinal study of African American individuals, and CMSP (0-10 numeric rating scale) and PTSS (impact of events scale, revised) outcomes were assessed 6 months following motor vehicle collision. Blood RNA were sequenced (n = 101) and the relationship between X chromosome mRNA expression levels and co-morbid CMSP and PTSS outcomes was evaluated using logistic regression analyses. A disproportionate number of peritraumatic X chromosome mRNA predicting CMSP and PTSS in women were genes previously found to escape X chromosome inactivation (11/40, z = -2.9, p = .004). Secondary analyses assessing gene ontology relationships between these genes identified an enrichment in genes known to influence neuronal plasticity. Further, the relationship of expression of two critical regulators of X chromosome inactivation, X-inactive specific transcript (XIST) and Yin Yang 1 (YY1), was different in women developing CMSP and PTSS. Together, these data suggest that X chromosome genes that escape inactivation may contribute to sex differences in vulnerability to CMSP and PTSS after motor vehicle collision.
Collapse
Affiliation(s)
- Shan Yu
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Constance Chen
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Yue Pan
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth Datner
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, FL
| | | | | | - Claire Pearson
- Department of Emergency Medicine, Detroit Receiving, Detroit, MI
| | - Robert Domeier
- Department of Emergency Medicine, St Joseph Mercy Health System, Ann Arbor, MI
| | - Samuel A. McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
8
|
Effects of a brief workplace-centered consultation for employees with musculoskeletal pain on health outcomes: a prospective cohort study. Sci Rep 2019; 9:5867. [PMID: 30971759 PMCID: PMC6458179 DOI: 10.1038/s41598-019-42387-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/29/2019] [Indexed: 12/21/2022] Open
Abstract
Musculoskeletal (MSK) diseases affect a substantial proportion of the population. Specialist consultations were offered at the workplace for people with musculoskeletal (MSK)-complaints. We analyzed data on pain and well-being as well as health economic data at baseline. Lasting effects of the consultation were analyzed at a follow-up-interview after 12 months. Baseline data of 344 individuals were available. Occupations were divided into physically highly demanding (HD) or less demanding. Women reported significantly higher pain levels and less QoL than men. Sick leave days were significantly more in HD-workers. Independent of workload, significantly higher percentages of women had cervical- and upper limb-pain than men, with significantly higher pain in upper limbs in HD-workers. 235 participants were available for telephone-follow-up. QoL and MSK-pain improved significantly. Yearly out-of-pocket spendings for treatments significantly increased. NSAID use significantly decreased, whereas use of non-drug musculoskeletal-medical-services was significantly higher after one year. Regarding MSK-symptoms in gainfully employed individuals, the study showed significantly different workload-dependent differences in QoL. Significant effects of a consultation by a MSK-specialist were shown in terms of improved MSK-pain and overall well-being. This workplace-centered consultation had significant effects on beneficial health-behavior such as decreased use of NSAID and increased engagement in gymnastics and physiotherapy.
Collapse
|
9
|
Teixeira MB, van Loon YT, Wasowicz DK, Langenhoff BS, van Ieperen RP, Zimmerman DDE. Use of Epidural Analgesia in Sigmoidectomy: Is There Any Advantage in the Era of Minimally Invasive Surgery? J Gastrointest Surg 2018; 22:1779-1784. [PMID: 29943135 DOI: 10.1007/s11605-018-3836-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/02/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is no consensus as to the effects of epidural analgesia on postoperative outcomes after laparoscopy in the context of the Enhanced Recovery Programs. The aim of this study was to evaluate the effects of epidural analgesia on postoperative outcomes after elective laparoscopic sigmoidectomy. METHODS The use of epidural analgesia was discontinued in elective laparoscopic sigmoidectomy and substituted by the perioperative administration of systemic lidocaine. Data from patients undergoing elective laparoscopic sigmoidectomy between January 2014 and September 2016 was prospectively analysed. Patients with epidural analgesia were compared with patients without, in analgesics administrated postoperatively, length of stay, day of first defecation and mobilisation, and complication and reoperation rates. RESULTS A total of 160 patients (male 85; female 75), median age 68 (30-92 years), were included. The groups consisted of 80 patients each. Mean length of stay (5.6 vs. 7.2 days, p = 0.03) and day of first mobilisation (mean 1.2 vs. 1.6 days, p = 0.004) were significantly shorter in the group without epidural analgesia. Reoperation rate (7.5 vs. 2.5%) was not statistically different. Complication rate was significantly lower (12.5 vs. 30%, p = 0.007) in the group without epidural. Day of first defecation was shorter in the epidural group (1.4 vs. 1.7 days, p = 0.04). Mean amount of analgesics administrated was not statistically different between groups, except for metamizole, that was administrated more in the group without epidural. CONCLUSIONS Epidural analgesia did not offer benefits on postoperative analgesia or outcomes after elective laparoscopic sigmoidectomy, causing longer length of stay, later mobilisation and higher complication rate.
Collapse
Affiliation(s)
- Mafalda Borges Teixeira
- Department of Surgery, Elisabeth - TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - Yu-Ting van Loon
- Department of Surgery, Elisabeth - TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - Dareczka K Wasowicz
- Department of Surgery, Elisabeth - TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - Barbara S Langenhoff
- Department of Surgery, Elisabeth - TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - Roland P van Ieperen
- Department of Anaesthesiology, Elisabeth - TweeSteden Hospital, Tilburg, the Netherlands
| | - David D E Zimmerman
- Department of Surgery, Elisabeth - TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, the Netherlands.
| |
Collapse
|
10
|
Shader RI. A Tribute to Gertrude Belle Elion on the 100th Anniversary of her Birth. Clin Ther 2018; 40:181-185. [DOI: 10.1016/j.clinthera.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
|
11
|
McGregor AJ. The Opioid Epidemic: Overcoming Challenges by Using a Sex and Gender Lens. Clin Ther 2018; 40:188-189. [PMID: 29395291 DOI: 10.1016/j.clinthera.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Alyson J McGregor
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|