Search

Introduction. Pain is the most common cause of complaints in hospitalized pediatric patients. Pain continues to be underestimated and undertreated in childhood. The European Society of Pediatric Anesthetists has published guidelines for pain management in children. Pain assessment. Pain assessment is very important in the treatment of pain in children. Basic pain management. Administration of basic analgesics is crucial for pain management. Paracetamol and non-steroidal anti-inflammatory drugs. Generally, basic or simple analgesia includes the use of paracetamol and non-steroidal anti-inflammatory drugs. Systemic opioids. Opioids are reserved for early postoperative and intraoperative use when adequate monitoring and specially trained personnel are available around the clock. Regional anesthesia and local anesthetics. Regional anesthesia in children has been increasingly used in recent decades, particularly against the background of multimodal analgesia. Conclusion. Basic analgesics are crucial, and opioids are added only when needed. Regional anesthesia and local anesthetics play a superior role in pain management compared to systemic analgesics in such cases in pediatric patients. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this work is to evaluate the impact of physical procedures on the functional status of patients with gonarthrosis. Material and Methods. 30 patients with knee osteoarthrosis were examined (9 male patients, 21 female patients) in the prospective study. All patients were treated on an outpatient basis in the Special Hospital for Rheumatic Diseases in Novi Sad during 2022. Functional status and quality of life were assessed with use of the Western Ontario and McMaster Universities Arthritis Index questionnaire and a specific questionnaire for patients with knee osteoarthrosis. The Western Ontario and McMaster Universities Arthritis Index is a standardized questionnaire used in the assessment of osteoarthrosis of the hip and knee. The specific questionnaire for patients with osteoarthrosis of the knee joint was created by the researchers and contains: general information, a visual-analog pain scale before and after therapy, and a table that monitors the range of motion of the lower extremities during treatment. The results obtained from this kind of research were processed with use of statistical methods. Statistical significance is defined at the probability level of the alternative hypothesis from p≤0.05 to p<0.001. Results. Correlation between the treatment outcome and patients’ individual characteristics (gender, age, type of work, time diagnosis) is shown. Conclusion. All patients had positive results and improved quality of life, as well as reduced soreness, after two weeks, regardless of their individual characteristics. [ABSTRACT FROM AUTHOR]

Introduction. The treatment of patients with lumbar disc herniation can be conservative or surgical, depending on the patient’s characteristics, the disease, and treatment possibilities. This study aims to compare the intensity of pain, the presence of Lasègue’s sign, and the degree of neurological deficits in patients with lumbar disc herniation before and after the operation. Additionally, the degree of intervertebral disc degeneration, evaluated by magnetic resonance imaging findings on the outcome will be determined. Material and Methods. A retrospective study involved 50 patients aged 18 to 45 who underwent microdiscectomy procedure. Parameters including pain intensity on the visual-analog scale, Lasègue’s nerve stretching test, sensory deficits, motor deficits, and the degree of intervertebral disc degeneration according to the Pfirrmann grading system were assessed preoperatively and in the early postoperative period. Results. Intervertebral disc herniation most commonly occurred at the L4-5 and L5-S1 levels in our patients. Pain intensity significantly decreased from a preoperative score of 7.6 to 2.4 postoperatively. There was also a significant decrease in the number of patients with positive Lasègue’s sign. According to the Pfirrmann grading system, 38% of patients had mild degenerative changes in the intervertebral disc, while 62% had severe degenerative changes. Conclusion. Microdiscectomy is the gold standard in surgical treatment of lumbar disc herniation. In the early postoperative period, patients experience a significant reduction in pain intensity with subsequent improvement of sensory and motor deficits. Surgical treatment of lumbar disc herniation, when indicated appropriately, carries a high success rate. [ABSTRACT FROM AUTHOR]

Acupuncture is a traditional Chinese therapeutic method that uses a sterile thin needle technique to puncture the skin at specific strategic points on the body. World Health Organisation has acknowledged acupuncture as a complementary treatment method for over 300 diseases. Nowadays, many available studies conducted in China, the United States, and Europe confirm the efficacy of acupuncture, its analgesic effect, while providing direct health benefits without or with minimal side-effects. There are many scientific evidence mechanisms of acupuncture’s analgesic effects. One of the mechanisms is described in the oldest and best-known Gate Control Theory which explains how pain pathways are modulated through normal anti-nociceptive pathways in the spinal cord. The second mechanism of analgesia shows that there are changes in descendent inhibition of pain pathway and secretion of neurotransmitters when the acupuncture needle is placed at the specific acupuncture point. In addition, it has been proved that there is an increased secretion of endogenous opioids during acupuncture procedures, which help reduce the pain sensations. Analgesic effects of acupuncture on cerebral function have been confirmed with use of functional magnetic resonance imaging and positron emission tomography scans. Although there is an increased number of relevant studies that confirm the effects and benefits of acupuncture therapy in the perioperative period, some important factors are still missing: the standardization process of acupuncture technique, the determination of types of surgery where the acupuncture method shows the best therapeutic effect, the determination of the best technique and time interval for the most effective analgesia. [ABSTRACT FROM AUTHOR]

Introduction. Ankylosing spondylitis is a common, chronic musculoskeletal condition associated with substantial functional limitations. Inflammation in later phases of the disease may lead to fibrosis and calcification of the spine, causing poor quality of life. This case report emphasizes the importance of early diagnosis of ankylosing spondylitis as one of the major factors in further course of the disease. Case report. A 27-yearold man was diagnosed with ankylosing spondylitis in 2019. He was first time examined in 2005 because of joint pain which was then characterized as growing pains. Symptoms of joint pain reappeared approximately 10 years later, and were present in lumbar and thoracic spine accompanied by morning stiffness. New pain spots also appeared, as well as positive laboratory results regarding inflammation. Despite the lasting diarrhea, additional tests such as anti-smooth muscle and anti-mitochondrial antibody, Hepatitis B surface Antigen and anti-Hepatitis C virus antibody test as well as stool test results all turned out to be negative. The magnetic resonance imaging showed edema of lower edges of the lumbosacral corpus, most likely as part of spondylitis, changes to the sacroiliac joints in terms of chronic phase of sacroiliitis with discrete activity, and right shoulder active synovitis. The human lymphocyte antigen B27 testing showed positive results. Despite the prescribed medical therapy, the disease activity remained high with positive clinical presentation. This patient may be a candidate for biological therapy. Conclusion. Early diagnosis and effective treatment provide reduction of pain, fatigue and disease activity and also prevent functional limitations, therefore improving the quality of life. [ABSTRACT FROM AUTHOR]

Introduction. Osteoarthritis is a degenerative rheumatic disease of the peripheral joints. It mostly affects one joint, usually the hip and knee joints, as well as the distal interphalangeal joints of the wrist and thumb carpometacarpal joint. The clinical symptoms include pain, swelling, stiffness, crepitus, muscle atrophy, subluxation, as well as reduced joint mobility, greatly affecting the quality of life of patients. The aim of this study was to assess the quality of life of patients with knee osteoarthritis and determine whether there is a difference in the quality of life of patients with unilateral and patients with bilateral knee osteoarthritis. Material and Methods. The study was designed as a retrospective study including 60 patients, 30 patients with unilateral gonarthrosis and 30 patients with bilateral gonarthrosis. The EuroQoL five dimensions questionnaire was used to assess the quality of life. Results. There is no statistically significant difference in the quality of life between individuals with unilateral and bilateral knee osteoarthritis, but there is a significant positive correlation between the pain intensity and difficulties in the domains of quality of life. Conclusion. People with osteoarthritis of the knee mostly take painkillers and have a good or excellent response to therapy. There is no statistically significant difference in the quality of life among people with unilateral and bilateral knee osteoarthritis. There is a significant positive correlation between the pain intensity and difficulties in the domains of quality of life. There is a significant negative correlation between the perception of general health and all five domains of quality of life. [ABSTRACT FROM AUTHOR]

Introduction. Mirror therapy was developed by Vilayanur Subramanian Ramachandran for the treatment of phantom pain after limb amputation. Mirror therapy is a neurorehabilitation technique that helps to relearn the use of affected limbs on many neurological and psychological levels. Material and Methods. A literature review was conducted using the following databases: KOBSON, Google Scholar, PubMed and MEDLINE. Results. A systematic literature review has shown that there is insufficient evidence of the effectiveness of this treatment in relieving and suppressing phantom limb pain. The results indicate the effectiveness of mirror therapy in relieving pain in people after a stroke. The small amount of evidence and lack of methodology reports have a major impact on the quality of this evidence. After mirror therapy, a significant reduction in pain at rest and during active movement was reported. Conclusion. Further research on mirror therapy is needed to help relieve pain. Evidence of the effectiveness of mirror therapy on pain has not been sufficiently investigated so far. [ABSTRACT FROM AUTHOR]

Introduction. The aim of the study was to determine the prevalence of orofacial pain in students and the impact of pain on their quality of life and everyday professional obligations. Material and Methods. A cross-sectional study included 319 respondents of both genders. Two questionnaires were used in this study; one that we specifically designed to detect orofacial pain among students and the Oral Impacts on Daily Performance questionnaire. Results. Of the total number of examinees, 101 (32%) reported that they had previously experienced pain in the orofacial region. Using the logistic regression analysis, we found that gender was an important predictor of pain and that female students had a 1.8 times higher risk for developing pain (p < 0.05). The highest prevalence of pain in our subjects was in the temporal region (7%; confidence interval 4%; 9%) and the region around the eye (6%; confidence interval 4%; 9%). Namely, in 65 (64.4%) students who had pain in the orofacial region, it had an impact on the quality of life and daily activities. The most prominent was the impact of the orofacial pain on the performance of their activities at the faculty. Orofacial pain has a significant impact on the psychosocial sphere, emotional and social contacts (12.3%; 14.1%). The temporomandibular joint pain and the pain when opening the mouth showed the least impact on the quality of life (p < 0.05). Conclusion. Orofacial pain is a condition that affects daily activities of students at the faculty, as well as their emotional and social life. [ABSTRACT FROM AUTHOR]

Introduction. Plantar calcaneal spur is a bony outgrowth which is most often located on the inferior aspect of the calcaneus, penetrating the surrounding soft tissues. Symptomatic and asymptomatic cases of plantar calcaneal spurs have been described and their analysis suggested that they may be a variation in regular bone development, but the exact cause is still unknown. The goal of this study was to determine the size, shape and prevalence of plantar spurs in the population of the Province of Vojvodina. Material and Methods. This retrospective research included a total of 272 foot X-rays. The X-rays belonged to the Clinic of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. The images were analyzed using a publicly available software Xrayline Workstation for 32-bit. Results. There was no statistically significant difference in the size of calcaneal spurs between sexes, as well as between the right/left foot. In regard to their shape, irregular calcaneal spurs were more frequent (61.9%) and all of the spurs were positioned horizontally. Conclusion. The results of this research were in agreement with the available literature data, showing no significant difference in morphometric analysis of the plantar spurs between sexes. Future researches should include data regarding the age, body weight, and comorbidities among examinees. [ABSTRACT FROM AUTHOR]

Introduction. The objective of the study was to determine the potentials and reliability of conditioned pain modulation effect in healthy population by application of a conditioning contact heat stimulus, and heat and pressure applied to the low back region as a test stimulus. Material and Methods. The study included 33 healthy subjects (average age 25.73 ± 5.35 years). Pressure and heat pain thresholds were examined on the paravertebral musculature of the lower back as test stimuli. Contact heat was used on the contralateral forearm as a conditioning stimulus. Conditioned pain modulation was calculated as the difference between pain thresholds after and before conditioning stimulus application. To assess the reliability, identical testing was performed 14 ± 2 days later. Results. The pressure and heat pain thresholds, after the conditioning stimulus, were significantly higher compared to pain thresholds obtained before the conditioning stimulus (101,63 N/cm2 ± 45,21N/cm2 vs 82,15 N/cm2 ± 36,15 N/cm2, t = -7,528, p < 0,001 and 47,08o C ± 2,19o C vs 45,00 ± 3,05o C, t = -6,644, p < 0,001, respectively). The reliability of the same protocol, measured 14 ± 2 days after the previous testing, showed good reliability of the pressure pain threshold (intraclass correlation coefficient = 0,636, 95% confidence interval 0,240 - 0,825), and fair of the heat pain threshold (intraclass correlation coefficient = 0,435, 95% confidence interval - 0,070 - 0,713). Conclusion. Conditioned pain modulation was successfully induced by contact heat applied via a thermode, a conditioning stimulus. The reliability of this method of testing proved to be fair when it comes to the heat pain threshold and good when it comes to the pressure pain threshold. [ABSTRACT FROM AUTHOR]

Introduction. Reactive arthritis is an autoimmune inflammatory rheumatic disease which develops as a reaction to urogenital or intestinal infections. Clinical Signs and Symptoms. It manifests as a peripheral asymmetrical monoarthritis or polyarthritis, mainly involving the lower extremities. Apart from joints, it can also affect the spinal cord, but also involve the muscle attachment sites, tendons, bursae, conjunctiva, anterior segment of the eye, damage to the skin and mucous membranes, causing typical asymmetrical sausage-like edema of fingers and/or toes. Diagnosis. The diagnosis is based on the Berlin Diagnostic Criteria including the characteristics of peripheral arthritis and evidence of previous infection. Approximately 65% - 85% of patients with reactive arthritis are positive for human leukocyte antigen - B27. Treatment of Reactive Arthritis. The therapy includes antibiotics chosen according to the antibiogram for the causative agent of the infection. The therapy is aimed at pain management and control of the autoimmune response of synovial lining of the joints, i.e. at prevention of articular damage. Drug therapy includes non-steroidal anti-inflammatory drugs, analgesics, steroids, immunosuppressive agents and biological drugs. Other methods of treatment are also recommended, such as rest in the acute phase of the disease, physical therapy and patient's education. Conclusion. Development of new diagnostic methods, particularly molecular diagnostics, and new therapeutic modalities using new generation drugs, has created conditions for more efficient treatment of reactive arthritis. [ABSTRACT FROM AUTHOR]

Introduction. Osteoid osteoma is a benign osteoblastic tumor, usually 1.5 - 2 cm in diameter, characterized by a well demarcated central area (osteoid nidus) surrounded by a sclerotic bone. It accounts for 5% of all primary bone tumors and most often affects the femur and tibia. The tumor is mostly seen in the second and third decades of life, more often in males, and the typical symptom is pain that worsens at night and responds well to analgesics. Case Report. We present a case of a young athlete, 11 years of age, who presented with characteristic symptoms and localization, as well as a typical radiographic finding. The timely action of a primary health care pediatrician and radiography reduced the time to definitive diagnosis and prompt surgical treatment was provided. The boy gradually started resuming his sports activities six months after the beginning of symptoms and 2.5 months after the surgery. Conclusion. In differential diagnosis of chronic leg pain in patients under the age of 18 years, primary health care pediatricians rely on medical history and physical examination, whereas after that plain radiography of the painful area should be considered. If the nidus is clearly seen in the X-ray, the possibility of diagnosing an osteoid osteoma increases, and timely and adequate treatment are provided. [ABSTRACT FROM AUTHOR]

Introduction. Healthcare workers should check if an oncology patient would like to be visited by a priest and if there are any religious rituals that would ease the treatment and eliminate the stress of people close to them. The aims of study have been to check if a lung cancer patient requires help from a priest during palliative oncological treatment and if a team for palliative care requires the presence of a priest. Material and Methods. The study included 200 lung cancer patients treated between 2015 and 2017 at the Institute for Pulmonary Diseases of Vojvodina. The sample was divided into two groups: patients with I, II, IIIA stage of carcinoma and the other with stadium of IIIB and IV. The research was performed by using a questionnaire to be completed by the patients. Results. A statistical significance was determined for the question "Do you think that the priest can participate in your treatment?" The percentage of male and female patients who answered positively was 38.9% and 71.6%, respectively (p<0.001). As for the patients with the stage of the disease IIIA and stage IIIB and IV, that percentage was 24.4%, and 71.1%, respectively (p<0.001). Conclusion. Lung cancer patients need help from a priest which is more common in females and in patients in later stages of the disease. The team for palliative care of lung cancer patients also needs the participation of a priest in their work with these patients. [ABSTRACT FROM AUTHOR]

Introduction. In our modern "high–tech""society, comfort of the patient is often forgotten because the practice is usually performed according to the bio-medical model and focused only on solving the physical problems of the patient rather than on a holistic approach. Therefore, the objective of this study was to assess the comfort level of patients hospitalized with the immobilization. Material and Methods. The study was conducted as an observational, analytical cross-sectional study by interviewing 124 patients hospitalized at the Clinical Centre of Vojvodina. Comfort Immobilization Questionnaire with 20 individual statements that describe the current good or bad condition of the patient was used as an instrument of research. Descriptive and inferential statistics methods were applied for statistical data processing and statistical significance was determined at p < 0.05. Results. The immobilized orthopedic patients reported a high level of comfort in the socio-cultural and spiritual context, which was, however, insufficient in the physical context and the immediate environment context. A low level of comfort was reported by the patients between the ages of 36 and 59 years and the patients with immobilization of the upper extremities. Comfort level was conditioned by the intensity of pain and applied analgesic therapy rather than the duration of applied immobilization. Conclusion. The results of this study indicate that the patients' comfort level is significantly affected by modifying factors such as hospital facilities as well as the type of immobilization and their age. Comfort Immobilization Questionnaire has proven to be a simple and reliable questionnaire for testing the patients comfort level in different contexts. [ABSTRACT FROM AUTHOR]

Introduction. Pyoderma gangrenosum is a rare, chronic, destructive, ulcerating skin disease of uncertain etiology. It develops most frequently in patients between 25-45 years of age and affects both sexes equally. Case report. We present a case of pyoderma gangrenosum in a young female patient who sustained a burn injury of 40% total body surface area. She underwent four operations. She developed a wound infection and urinary infection during her hospital stay. By the end of hospitalization, the papules followed with coalesce of ulcerations formed on the previously epithelized areas of her legs. The patient complained of the intensive pain localized on these surfaces. Since pyoderma gangrenosum was suspected, a dermatologist was included in treatment. Therapy was initiated (methylprednisolone 60 mg per day intravenously) with gradual reduction of the dosage. The patient was discharged from hospital two weeks later with almost fully complete cicatrization and epithelization. Conclusion. Pyoderma gangrenosum is still difficult to be diagnosed in the absence of specific and sensitive diagnostic methods; however, it is crucial to be suspected as early as possible and to start treatment immediately. Multidisciplinary approach is essential for optimal results. [ABSTRACT FROM AUTHOR]

Introduction. Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential diagnosis and the efficacy of rehabilitation treatment. Case report. A 25-year old male patient sought medical help complaining of the pain along the distal third of tibia. The pain was present on palpation of the distal two-thirds of the lateral and medial tibial border over the length of 9 cm and on muscle manual testing of foot flexors. The patient underwent physical and exercise treatment for three weeks. The recovery was monitored by visual analogue scale, which measured the lower leg pain, pain on palpation and manual muscle testing. In addition, the patient himself assessed his ability to resume sport activities on the 5-point Likert scale. The final evaluation and measurements showed his complete functional recovery. Conclusion. The results obtained in this case show the importance of accurate clinical diagnosis and rehabilitation for medial tibial stress syndrome [ABSTRACT FROM AUTHOR]

Introduction Ethiopathogenesis of dysfunction and pain in temporomandibular joints has been the subject of passionate discussions between supporters of purely mechanical conception and the ones who are supporters of psyhosomatic conception. The aim of the study: Relying on neurophysiological data, the authors are trying to reveal the main role of reticular mesencephalical formation in mechanisms which provoke craniomandibular dysfunctions and confront the influence of emotional factors from neocortex and painful stimuli from oral structures. Discussion From dynamical point of view, not only the morphological aspects of teeth and arcades, but also sensitive-sensorial mechanisms connected to masticatory muscles, periodontal structures and oral structures, should he considered. The ideal bite and perfect morphology of tooth arcades are not enough for reconstitution of correct occlusion, if there are no neuromuscular system, temporomandibular joint, and especially central nervous system. Conclusion The presence of pain is just one of the craniomandibular dysfunction symptoms, but if it is added to the other clinical signs and emotional or affect - provoking factor, it will provoke dysfunctional syndrome. [ABSTRACT FROM AUTHOR]

Definition of pain The International Association for the Study of Pain has defined pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." The interpretation of pain is subjective. Each person forms an internal construct of pain through encountered injury. Pain and newborn The issue of pain perception in newborns, its management and prevention has been neglected for decades. The inability of "self-report" of painful experience has contributed significantly to misunderstanding of the importance of this problem and inadequate treatment. The main characteristic of this 'critical window of brain development' period is rapid enlargement of brain volume and its great plasticity. Harmful short-term and long-term consequences can arise as a consequence of disturbance of the sophisticated balance between newborn and its surrounding. Neonatal pain indicators As a response to a present painful stimulus, the newborn adapts to this acute stress with changes in endocrine, vegetative, immune and behavioral area. An ideal pain indicator in neonatal period does not exist. There are several different groups of them, namely contextual and developmental indicators (gestational age, contributed illness, medication, for example), physiological mean rate, vagal tone, breathing rate, blood pressure, oxygen saturation, transcutaneaus partial pressures of oxygen and carbon-dioxide, intracranial pressure, palm sweating) and behavioral ones (face expression. movements of limbs, cry) several neonatal pain scales were constructed on the basis of these indicators. [ABSTRACT FROM AUTHOR]