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Vollert J, Wang R, Regis S, Yetman H, Lembo AJ, Kaptchuk TJ, Cheng V, Nee J, Iturrino J, Loscalzo J, Hall KT, Silvester JA. Genotypes of Pain and Analgesia in a Randomized Trial of Irritable Bowel Syndrome. Front Psychiatry 2022; 13:842030. [PMID: 35401282 PMCID: PMC8983929 DOI: 10.3389/fpsyt.2022.842030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a highly prevalent chronic pain disorder with multiple underlying mechanisms and few treatments that have been demonstrated to be effective in placebo controlled trials. One potential reason may be the use of composite outcomes, such as the IBS Symptom Severity Scale (IBS-SSS) which includes descriptive items related to pain frequency and pain intensity as well as bowel dysfunction and bloating. We investigated if different features of IBS pain have distinct genetic associations and if these may be moderated by sex hormones. PARTICIPANTS AND SETTING Adult outpatients with moderately severe IBS (>175 on IBS-SSS) enrolled in a clinical trial reported IBS-SSS at baseline and after 6 weeks of therapy. METHODS Fixed effects modeling was used to test the effect of COMT rs4680 genotype to change in pain severity (rated 0-100) and pain frequency (defined as number of days with pain in the past 10 days) from baseline to week 6 with IBS treatment. Parallel exploratory genome-wide association studies (GWAS) were also performed to identify single nucleotide polymorphisms (SNPs) associated with change in pain severity or pain frequency across all participants. RESULTS A total of 212 participants (74% female) were included. The COMT rs4680 met allele was associated with decreased pain severity over the course of the trial in gene dosage models [beta(SE) -5.9 (2.6), P = 0.028]. Exploratory GWAS for change in pain frequency identified 5 SNPs in close proximity on chromosome 18 near L3MBTL4 which reached genome-wide significance (all P < 5.0E-8). This effect was not mediated by changing estradiol levels. There was also a region of chromosome 7 with 24 SNPs of genome-wide suggestive significance for change in pain severity (all P < 1.0E-5). CONCLUSIONS Previously reported association between COMT rs4680 genotype and treatment response as measured by IBS-SSS is related to pain severity, but not pain frequency. We also identified new candidate genes associated with changes in IBS pain severity (SNX13) and pain frequency (L3MBTL4) in response to treatment. Further studies are needed to understand these associations and genetic determinants of different components of IBS-SSS. ClinicalTrials.gov, Identifier: NCT0280224.
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Affiliation(s)
- Jan Vollert
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.,Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany.,Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.,Mannheim Center of Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ruisheng Wang
- Department of Medicine, Brigham Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Stephanie Regis
- Division of Gastroenterology, Boston Children's Hospital, Boston, MA, United States
| | - Hailey Yetman
- Department of Medicine, Brigham Women's Hospital, Boston, MA, United States
| | - Anthony J Lembo
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ted J Kaptchuk
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Program in Placebo Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of General Medicine Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Vivian Cheng
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Judy Nee
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Johanna Iturrino
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joseph Loscalzo
- Department of Medicine, Brigham Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Kathryn T Hall
- Department of Medicine, Brigham Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Jocelyn A Silvester
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Gastroenterology, Boston Children's Hospital, Boston, MA, United States.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Short NA, Sullivan J, Soward A, Bollen KA, Liberzon I, Martin S, Rauch SAM, Bell K, Rossi C, Lechner M, Novak C, Witkemper K, Kessler RC, McLean SA. Protocol for the first large-scale emergency care-based longitudinal cohort study of recovery after sexual assault: the Women's Health Study. BMJ Open 2019; 9:e031087. [PMID: 31753875 PMCID: PMC6887008 DOI: 10.1136/bmjopen-2019-031087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Worldwide, an estimated 10%-27% of women are sexually assaulted during their lifetime. Despite the enormity of sexual assault as a public health problem, to our knowledge, no large-scale prospective studies of experiences and recovery over time among women presenting for emergency care after sexual assault have been performed. METHODS AND ANALYSIS Women ≥18 years of age who present for emergency care within 72 hours of sexual assault to a network of treatment centres across the USA are approached for study participation. Blood DNA and RNA samples and brief questionnaire and medical record data are obtained from women providing initial consent. Full consent is obtained at initial 1 week follow-up to analyse blood sample data and to perform assessments at 1 week, 6 weeks, 6 months and 1 year. These assessments include evaluation of survivor life history, current health and recovery and experiences with treatment providers, law enforcement and the legal system. ETHICS AND DISSEMINATION This study is approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB) and the IRB of each participating study site. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.
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Affiliation(s)
- Nicole A Short
- Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jenyth Sullivan
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - April Soward
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University System Health Science Center College of Medicine, Bryan, Texas, USA
| | - Sandra Martin
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Kathy Bell
- Tulsa Forensic Nursing, Tulsa Police Department, Tulsa, Oklahoma, USA
| | - Catherine Rossi
- Forensic Nursing, Cone Health, Greensboro, North Carolina, USA
| | - Megan Lechner
- Forensic Nurse Examining Team, University of Colorado Health Colorado Springs, Colorado Springs, Colorado, USA
| | - Carissa Novak
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Witkemper
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel A McLean
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Lin YC, Huang CC, Su NY, Lee CL, Lao HC, Lin CS, Chen CC. Patient-controlled analgesia for background pain of major burn injury. J Formos Med Assoc 2018; 118:299-304. [PMID: 29804733 DOI: 10.1016/j.jfma.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/07/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies have suggested that intravenous patient-controlled analgesia (IV-PCA) can be used safely for the treatment of background pain in burn patients. However, no comprehensive protocols have been published. How patient or surgical factors correlate with the amount of opioid consumption remains unclear. The aim of this study is to provide an IV-PCA protocol for alleviating pain for burn injuries, and to assess factors correlated with opioid consumption. METHODS At the Mackay Memorial Hospital, a retrospective analysis from June 27th to October 31st of 2015 was carried out to investigate the use of IV-PCA in relation to the demographic and clinical data of patients who suffered from burn injuries due to a massive explosion of flammable powder. A standardized morphine IV-PCA protocol with rapid escalation was implemented. Variables assessed included age, weight, gender, days of usage, total surface area burned (TBSAB) and operations. RESULTS Among the 23 patients who received IV-PCA for burn pain control, it was noted that the larger the TBSAB and the higher the visual analogue scale (VAS), the more amount of morphine was consumed. Correlations between morphine consumption positively with weight (P < 0.01), female gender (P < 0.01), severity of injury (P = 0.01), and negatively with receiving operations (P = 0.01) were statistically significant. CONCLUSION As the daily morphine consumption was positively correlated with TBSAB, VAS, weight, female gender, the use of our IV-PCA protocol was sufficient in the management of background pain for patients with major burn injury.
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Affiliation(s)
- Ying-Chun Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Chien-Chung Huang
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan.
| | - Nuan-Yen Su
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Chia-Lin Lee
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Hsuan-Chih Lao
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Shiang Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chuan Chen
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
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Abstract
Catecholamine-O-methyltransferase (COMT) is a polymorphic gene whose variants affect enzymatic activity and pain sensitivity via adrenergic pathways. Although COMT represents one of the most studied genes in human pain genetics, findings regarding its association with pain phenotypes are not always replicated. Here, we investigated if interactions among functional COMT haplotypes, stress, and sex can modify the effect of COMT genetic variants on pain sensitivity. We tested these interactions in a cross-sectional study, including 2 cohorts, one of 2972 subjects tested for thermal pain sensitivity (Orofacial Pain: Prospective Evaluation and Risk Assessment) and one of 948 subjects with clinical acute pain after motor vehicle collision (post-motor vehicle collision). In both cohorts, the COMT high-pain sensitivity (HPS) haplotype showed robust interaction with stress and number of copies of the HPS haplotype was positively associated with pain sensitivity in nonstressed individuals, but not in stressed individuals. In the post-motor vehicle collision cohort, there was additional modification by sex: the HPS-stress interaction was apparent in males, but not in females. In summary, our findings indicate that stress and sex should be evaluated in association studies aiming to investigate the effect of COMT genetic variants on pain sensitivity.
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Nyland JE, McLean SA, Averitt DL. Prior stress exposure increases pain behaviors in a rat model of full thickness thermal injury. Burns 2015; 41:1796-1804. [PMID: 26432505 DOI: 10.1016/j.burns.2015.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/25/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
Thermal burns among individuals working in highly stressful environments, such as firefighters and military Service Members, are common. Evidence suggests that pre-injury stress may exaggerate pain following thermal injury; however current animal models of burn have not evaluated the potential influence of pre-burn stress. This sham-controlled study evaluated the influence of prior stress exposure on post-burn thermal and mechanical sensitivity in male Sprague-Dawley rats. Rats were exposed to 20 min of inescapable swim stress or sham stress once per day for three days. Exposure to inescapable swim stress (1) increased the intensity and duration of thermal hyperalgesia after subsequent burn and (2) accelerated the onset of thermal hyperalgesia and mechanical allodynia after subsequent burn. This stress-induced exacerbation of pain sensitivity was reversed by pretreatment and concurrent treatment with the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine. These data suggest a better understanding of mechanisms by which prior stress augments pain after thermal burn may lead to improved pain treatments for burn survivors.
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Affiliation(s)
- Jennifer E Nyland
- Pain Management Research Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States.
| | - Samuel A McLean
- Departments of Anesthesiology and Emergency Medicine, University of North Carolina at Chapel Hill, NC, United States
| | - Dayna L Averitt
- Department of Biology, Texas Woman's University, Denton, TX, United States
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Results of a pilot multicenter genotype-based randomized placebo-controlled trial of propranolol to reduce pain after major thermal burn injury. Clin J Pain 2015; 31:21-9. [PMID: 25084070 DOI: 10.1097/ajp.0000000000000086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Results of previous studies suggest that β-adrenoreceptor activation may augment pain, and that β-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high-activity haplotype. MATERIALS AND METHODS Consenting patients admitted for thermal burn injury at participating burn centers were genotyped; those who were not high-activity COMT homozygotes were randomized to propranolol 240 mg/d or placebo. Primary outcomes were study feasibility (consent rate, protocol completion rate) and pain scores on study days 5 to 19. Secondary outcomes assessed pain and posttraumatic stress disorder symptoms 6 weeks postinjury. RESULTS Seventy-seven percent (61/79) of eligible patients were consented and genotyped, and 77% (47/61) were genotype eligible and randomized. Ninety-one percent (43/47) tolerated study drug and completed primary outcome assessments. In intention-to-treat and per-protocol analyses, patients randomized to propranolol had worse pain scores on study days 5 to 19. CONCLUSIONS Genotype-specific pain medication interventions are feasible in hospitalized burn patients. Propranolol is unlikely to be a useful analgesic during the first few weeks after burn injury.
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7
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Oladosu FA, Maixner W, Nackley AG. Alternative Splicing of G Protein-Coupled Receptors: Relevance to Pain Management. Mayo Clin Proc 2015; 90:1135-51. [PMID: 26250730 PMCID: PMC5024555 DOI: 10.1016/j.mayocp.2015.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/13/2015] [Accepted: 06/26/2015] [Indexed: 01/01/2023]
Abstract
Drugs that target G protein-coupled receptors (GPCRs) represent the primary treatment strategy for patients with acute and chronic pain; however, there is substantial individual variability in both the efficacy and adverse effects associated with these drugs. Variability in drug responses is due, in part, to individuals' diversity in alternative splicing of pain-relevant GPCRs. G protein-coupled receptor alternative splice variants often exhibit distinct tissue distribution patterns, drug-binding properties, and signaling characteristics that may impact disease pathology as well as the extent and direction of analgesic effects. We review the importance of GPCRs and their known splice variants to the management of pain.
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Affiliation(s)
- Folabomi A Oladosu
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill
| | - William Maixner
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill
| | - Andrea G Nackley
- Center for Pain Research and Innovation, University of North Carolina, Chapel Hill.
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Common variants of catechol-O-methyltransferase influence patient-controlled analgesia usage and postoperative pain in patients undergoing total hysterectomy. THE PHARMACOGENOMICS JOURNAL 2015; 16:186-92. [DOI: 10.1038/tpj.2015.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/16/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022]
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9
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Neuropathic ocular pain: an important yet underevaluated feature of dry eye. Eye (Lond) 2014; 29:301-12. [PMID: 25376119 DOI: 10.1038/eye.2014.263] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/06/2014] [Indexed: 12/16/2022] Open
Abstract
Dry eye has gained recognition as a public health problem given its prevalence, morbidity, and cost implications. Dry eye can have a variety of symptoms including blurred vision, irritation, and ocular pain. Within dry eye-associated ocular pain, some patients report transient pain whereas others complain of chronic pain. In this review, we will summarize the evidence that chronicity is more likely to occur in patients with dysfunction in their ocular sensory apparatus (ie, neuropathic ocular pain). Clinical evidence of dysfunction includes the presence of spontaneous dysesthesias, allodynia, hyperalgesia, and corneal nerve morphologic and functional abnormalities. Both peripheral and central sensitizations likely play a role in generating the noted clinical characteristics. We will further discuss how evaluating for neuropathic ocular pain may affect the treatment of dry eye-associated chronic pain.
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Halpern CT, Tucker CM, Bengtson A, Kupper LL, McLean SA, Martin SL. Somatic symptoms among US adolescent females: associations with sexual and physical violence exposure. Matern Child Health J 2014; 17:1951-60. [PMID: 23340952 DOI: 10.1007/s10995-013-1221-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The objective of this study is to examine the association between physical and sexual violence exposure and somatic symptoms among female adolescents. We studied a nationally representative sample of 8,531 females, aged 11-21 years, who participated in the 1994-1995 Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Female adolescents were asked how often they had experienced 16 specific somatic symptoms during the past 12 months. Two summary categorical measures were constructed based on tertiles of the distributions for the entire female sample: (a) total number of different types of symptoms experienced, and (b) number of frequent (once a week or more often) different symptoms experienced. Groups were mutually exclusive. We examined associations between adolescents' violence exposure and somatic symptoms using multinomial logistic regression analyses. About 5 % of adolescent females reported both sexual and non-sexual violence, 3 % reported sexual violence only, 36 % reported non-sexual violence only, and 57 % reported no violence. Adolescents who experienced both sexual and non-sexual violence were the most likely to report many different symptoms and to experience very frequent or chronic symptoms. Likelihood of high symptomatology was next highest among adolescents who experienced sexual violence only, followed by females who experienced non-sexual violence only. Findings support an exposure-response association between violence exposure and somatic symptoms, suggesting that symptoms can be markers of victimization. Treating symptoms alone, without addressing the potential violence experienced, may not adequately improve adolescents' somatic complaints and well-being.
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Affiliation(s)
- Carolyn Tucker Halpern
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #8120, Carolina Population Center, Chapel Hill, NC, 27599-8120, USA,
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12
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Abstract
Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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McLean SA, Soward AC, Ballina LE, Rossi C, Rotolo S, Wheeler R, Foley KA, Batts J, Casto T, Collette R, Holbrook D, Goodman E, Rauch SAM, Liberzon I. Acute severe pain is a common consequence of sexual assault. THE JOURNAL OF PAIN 2012; 13:736-41. [PMID: 22698980 DOI: 10.1016/j.jpain.2012.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/04/2012] [Accepted: 04/30/2012] [Indexed: 01/12/2023]
Abstract
UNLABELLED Sexual assault (SA) is common, but the epidemiology of acute pain after SA has not previously been reported. We evaluated the severity and distribution of pain symptoms in the early aftermath of SA among women receiving Sexual Assault Nurse Examiner (SANE) care, and the treatment of pain by SANE nurses. Severe pain (≥7 on a 0-10 numeric rating scale) was reported by 53/83 women sexual assault survivors (64% [95% CI, 53-74%]) at the time of SANE evaluation and 43/83 women (52% [95% CI, 41-63%]) 1 week later. Pain in 4 or more body regions was reported by 44/83 women (53% [95% CI, 42-64%]) at the time of initial evaluation and 49/83 women (59% [95% CI, 48-70%]) at 1 week follow-up. Among survivors with severe pain at the time of initial postassault evaluation, only 7/53 (13% [95% CI, 6-26%]) received any pain medication at the time of initial SANE treatment. These findings suggest that pain is common in SA survivors in the early postassault period, but rarely treated. PERSPECTIVE Acute pain is common after sexual assault. Practice guidelines for SANE nurses and others who provide care to sexual assault survivors in the early aftermath of assault should include specific recommendations for pain evaluation and treatment. Prospective longitudinal studies of pain outcomes among sexual assault survivors are needed.
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Affiliation(s)
- Samuel A McLean
- TRYUMPH Research Program, University of North Carolina, Chapel Hill, North Carolina 27599-7010, USA.
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