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Abstract: This study sought to determine whether mothers of young people with chronic abdominal pain (CAP) compared to mothers of pain-free children show a pain recognition bias when they classify facial emotional expressions. One hundred demographically matched mothers of children with CAP (n =50) and control mothers (n =50) were asked to identify different emotions expressed by adults in 2 experiments. In experiment 1, participants were required to identify the emotion in a series of facial images that depicted 100% intensity of the following emotions: Pain, Sadness, Anger, Fear, Happiness, and Neutral. In experiment 2, mothers were required to identify the predominant emotion in a series of computer-interpolated (“morphed”) facial images. In this experiment, pain was combined with Sad, Angry, Fearful, Happy, and Neutral facial expressions in different proportions—that is, 90%:10%, 70%:30%, 50%:50%, 30%:70%, 10%:90%. All participants completed measures of state and trait anxiety, depression, and anxiety sensitivity. In experiment 1, there was no difference in the performance of the 2 groups of mothers. In experiment 2, it was found that overall mothers of children with CAP were classifying ambiguous emotional expressions predominantly as pain. Mean response times for CAP and control groups did not differ significantly. Mothers of children with CAP did not report more anxiety, depression, and anxiety sensitivity compared to control mothers. It is concluded that mothers of children with CAP show a pain bias when interpreting ambiguous emotional expressions, which possibly contributes to the maintenance of this condition in children via specific parenting behaviours. [Copyright &y& Elsevier]

In this article, the authors discuss the improvement in postoperative pain management. They mention the challenge for practitioners to develop treatment for pain after surgical procedures despite advances on the physiology of acute pain. Moreover, they present the concepts of analgesia through opioid and non-opioid analgesics and suggest the need for improvement of analgesia through combination of analgesics with additive or synergistic effects.

Abstract: Venepuncture for blood sampling can be a distressing experience for a considerable number of children. A prospective controlled trial was conducted to compare the efficacy of a local anaesthetic (EMLA) with a combination of EMLA with self-hypnosis in the relief of venepuncture-induced pain and anxiety in 45 paediatric cancer outpatients (age 6–16years). A secondary aim of the trial was to test whether the intervention will have a beneficial effect on parents’ anxiety levels during their child’s procedure. Patients were randomized to one of three groups: local anaesthetic, local anaesthetic plus hypnosis, and local anaesthetic plus attention. Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety, and less procedure-related pain and anxiety, and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups. Parents whose children were randomized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child’s procedure than parents whose children had been randomized to the other two conditions. The therapeutic benefit of the brief hypnotic intervention was maintained in the follow-up. The present findings are particularly important in that this study was a randomized, controlled trial conducted in a naturalistic medical setting. In this context, convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self-hypnosis, an intervention that can be easily taught to children, is noninvasive and poses minimal risk to young patients and their parents. [Copyright &y& Elsevier]

Case Diagnosis: Case Description: Two rehabilitative inpatients with spinal cord injury (SCI), both with C6 ASIA B level, were followed serially for percutaneous endoscopic gastrostomy (PEG) removal using the cut and push method, electively, in lieu of traction removal. Patient A's PEG was removed one week prior to home discharge, 102 days post injury, 90 days post initial placement, in stable condition having had neurogenic bowel managed by digital stimulation for 45 days. Patient B's PEG was removed 16 days prior to home discharge, 115 days post injury, 86 days post initial placement, in stable condition having had neurogenic bowel managed by digital stimulation for 71 days. Case Description: Results: For both patients, PEG catheters were retracted to approximate the skin level prior to incising with scissors. The remnant catheter was pushed through the PEG apperture using a hemostat. Serial abdominal radiographs were attained to visualize intestinal transit by the remnant catheter. For patient A, catheter remnant was visualized radiographically on post removal day 2 in the left lower quadrant and found during bowel program on post removal day 4. Patient A remained stable with bowel incontinence on day 1 and 4. Patient B's catheter remnant was visualized in the left upper quadrant on post removal day 2, left abdomen on day 6, right upper quadrant on day 8, left lower quadrant on day 10, and not visible on day 13. Patient B remained stable with bowel incontinence on day 2. Discussions: These are the first reported cases, to our knowledge, of a "cut and push" method used for the removal of PEG catheters in spinal cord injury patients with neurogenic bowel without complications. Conclusions: "Cut and push" method for PEG tube removal in spinal cord patients with neurogenic bowel was successful and appropriate and could take between 3-13 days. Theoretical advantages over traction pull removal would be alleviation of pain, dysreflexia, and PEG site irritation. [ABSTRACT FROM AUTHOR]

Case: We present a 26-year-old active duty man who sustained a coccygeal fracture and gluteus maximus hematoma after a fall from height during training. The patient returned 3 weeks postinjury with symptoms and physical examination findings concerning for gluteal compartment syndrome. An expanding gluteal hematoma was confirmed on imaging and the patient was taken to the operating room for emergent evacuation and endovascular hemostasis. Conclusions: This case of gluteal compartment syndrome is a unique contribution to the literature with respect to the specific vascular injury observed and the delayed presentation of gluteal compartment syndrome. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Improving Postoperative Pain Management: What Are the Unresolved Issues?" by P. F. White and H. Kehlet.

This study sought to determine whether mothers of young people with chronic abdominal pain (CAP) compared to mothers of pain-free children show a pain recognition bias when they classify facial emotional expressions. One hundred demographically matched mothers of children with CAP (n=50) and control mothers (n=50) were asked to identify different emotions expressed by adults in 2 experiments. In experiment 1, participants were required to identify the emotion in a series of facial images that depicted 100% intensity of the following emotions: Pain, Sadness, Anger, Fear, Happiness, and Neutral. In experiment 2, mothers were required to identify the predominant emotion in a series of computer-interpolated ("morphed") facial images. In this experiment, pain was combined with Sad, Angry, Fearful, Happy, and Neutral facial expressions in different proportions-that is, 90%:10%, 70%:30%, 50%:50%, 30%:70%, 10%:90%. All participants completed measures of state and trait anxiety, depression, and anxiety sensitivity. In experiment 1, there was no difference in the performance of the 2 groups of mothers. In experiment 2, it was found that overall mothers of children with CAP were classifying ambiguous emotional expressions predominantly as pain. Mean response times for CAP and control groups did not differ significantly. Mothers of children with CAP did not report more anxiety, depression, and anxiety sensitivity compared to control mothers. It is concluded that mothers of children with CAP show a pain bias when interpreting ambiguous emotional expressions, which possibly contributes to the maintenance of this condition in children via specific parenting behaviours. [ABSTRACT FROM AUTHOR]