PubMed Health⌕ Search

Biomedical subjects

Manon Choinière

Publications and source records attributed to Manon Choinière.

15 recordsLinked to original sources
PubMed2006

Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study.

OBJECTIVE: This study was designed to assess the prevalence, characteristics, effect, and predictors of chronic postoperative pain 1 to 3 years after cardiac surgery. METHODS: Seven hundred thirty-six patients who underwent coronary artery bypass surgery, valve replacement, or both between 1999 and 2002 were mailed questionnaires (response rate, 79% [n = 579]; 564 questionnaires were analyzed), and their hospital records were reviewed. RESULTS: Nonanginal chronic postoperative pain affected 23% of patients. Eighty percent of them had pain 1 or more days per week. The worst and usual pain intensities during the week preceding the survey reached moderate to severe levels (> or =4/10) in more than half of the patients. Thirty-one percent of the patients with chronic postoperative pain had taken analgesic pain medication during that week. During the same period, pain interfered significantly (> or =4/10) with various aspects of patients' daily life (eg, general activity level: 39.1%, sleep: 36.7%). When patients with and without chronic postoperative pain were compared, the former group had significantly higher levels of anxiety and depression, and they perceived their health-related quality of life as more compromised. Multivariate logistic regression analysis revealed that greater analgesic needs in the first few days postoperatively were associated with an increased risk of chronic postoperative pain. The only other significant factor was the time elapsed from surgical intervention to survey: the longer it was, the less likely the patients were to report chronic postoperative pain. CONCLUSION: The prevalence, severity, and effect of chronic postoperative pain after cardiac surgery should not be underestimated. Longitudinal prospective studies are needed to further evaluate risk factors, including inadequate postoperative pain relief in the acute period.

Adult↗
PubMed2005

Sensory perception and neuroanatomical structures in normal and grafted skin of burn survivors.

BACKGROUND: This study compared the neural structures found in grafted skin of burn survivors with neural structures found in site-matched normal skin and correlated these structures with psychophysical measures of sensation. METHODS: Fifteen skin-grafted male burn survivors (47.7+/-10.4 years old) with deep partial- or full-thickness thermal burn injuries covering an average of 11+/-5.6% of their total body surface and with normal skin at a matching, unburned, contralateral site were recruited into this study. Threshold determinations and magnitude estimations for touch, cold, warmth and heat-pain were performed at sites with grafted and normal skin, using Semmes-Weinstein monofilaments and the Medoc TSA 2001 thermal stimulator. Skin biopsies from both the grafted and normal sites were stained with antibodies for protein gene product 9.5 (PGP) and neurofilament 200 kDa. Nerve fibers in the epidermis and nerve fibers or bundles of nerve fibers in the superficial and deep dermis as well as innervated blood vessels, hair follicles and sweat glands were counted. RESULTS: On average, the data were collected 43.1+/-10.4 months after grafting. When thresholds on grafted skin were compared to thresholds on normal skin, they showed elevated sensory thresholds [touch (p<0.003), cold (p<0.031), warmth (p<0.009)]. Magnitude estimates of touch, cold and warmth differed on the two sides with sensations elicited from grafts being smaller than those from normal skin. Heat-pain thresholds and heat-pain magnitude estimations were not statistically different on the two sites. By comparison to the normal side, and consistent with the attenuated sensory functions of the grafts, counts of neural structures showed a reduction in innervation density; PGP-immunoreactive nerve fibers/bundles were reduced in grafted epidermis (p<0.026) and superficial dermis (p<0.001). The numbers of sweat glands (p<0.006) and hair follicles (p<0.001) were also reduced. The number of innervated blood vessels did not differ significantly on the two sides. There were significant correlations between sensory thresholds and the neuroanatomical variables: thresholds of cold and touch were correlated with the number of sweat glands in both grafted and normal skin (r2=0.56 and 0.50, respectively; p<0.001), while warmth thresholds were significantly correlated with the number of innervated blood vessels in grafted skin (r2=0.62, p<0.001). Encapsulated mechanoreceptors were not encountered in this study of hairy skin. CONCLUSIONS: Touch, cold and warmth thresholds and magnitude estimations do not return to normal levels after skin grafting in burn survivors. The elevation of thresholds and reduction of sensory intensity is accompanied by a general decrease in the density of nerve terminals. The lack, or numerical reduction, of sweat glands and innervated blood vessels was also indicative of diminished sensation on grafted skin.

Adult↗
PubMed2005

Acute intravenous administration of morphine perturbs sleep architecture in healthy pain-free young adults: a preliminary study.

STUDY OBJECTIVES: Pain is a leading cause of sleep disturbances in medical illness. Providing effective analgesia is considered an important intervention to reduce these sleep disturbances. Opioids remain the treatment of choice to relieve postoperative pain in hospitalized patients. However, their effects on sleep in pain patients or normal subjects remain unclear, as previous studies have been conducted mainly with former opioid addicts. The purpose of this investigation was to evaluate and describe the effects of acute clinical doses of morphine on sleep in healthy pain-free subjects. DESIGN: Subjects were randomly assigned to untreated (baseline), morphine (intravenous injections of 0.1 [DOSAGE ERROR CORRECTED] mg/kg), and placebo (intravenous injections of 0.9% NaCI) conditions. SETTING: Sleep laboratory. PARTICIPANTS: Seven healthy pain-free, nonaddicts (5 women, 2 men; mean age = 25 +/- 1.6 years). MEASUREMENTS AND RESULTS: Standard polysomnographic sleep and respiratory variables were measured during 3 experimental conditions. The treatment effect was analyzed with a Latin square cross-over design followed, when appropriate, by Tukey contrasts. Morphine altered sleep architecture by reducing slow-wave sleep (non-rapid eye movement stages 3-4) and rapid eye movement sleep, and by increasing non-rapid eye movement stage 2 sleep. Results did not reveal any statistical differences for other sleep and respiratory variables. CONCLUSIONS: Similar to earlier findings in animals, nondependent opiate addicts, and postoperative patients, morphine was found to reduce duration of slow-wave sleep. Unlike previous reports, however, its acute administration produced a moderate reduction in rapid eye movement sleep and did not increase correlates of arousal (ie, awakenings, electroencephalogram arousals, wake after sleep onset). Future studies should correlate these findings in patients with pain and evaluate whether optimal pain relief with opioid therapy can improve sleep disturbances in pain patients.

Adult↗
PubMed2004

Acute postoperative pain in lung transplant recipients.

BACKGROUND: This retrospective study was designed to assess the quality of postoperative pain control and the facility of transition from epidural to oral analgesia in lung transplant recipients. METHODS: After institutional review board approval, data were collected from the charts of all patients who underwent lung transplantation at our institution between 1998 and 2002. The study group consisted of the patients for whom an epidural was the first postoperative pain management modality. To serve as a control group we reviewed the charts of 30 patients, randomly selected over the same period, who underwent a thoracotomy for indications other than transplantation and who received postoperative epidural analgesia. RESULTS: Eighty-three patients were available for analysis. Unilateral and bilateral lung transplant recipients had equivalent quality of pain control. However, lung transplant recipients had a lower incidence of adequate pain relief than patients undergoing thoracotomy for other indications (73% vs 87%, p < 0.05). Lung transplant recipients also had a higher incidence of epidural to oral analgesia transition failure (47% vs 20%, p < 0.01). CONCLUSIONS: This is the first study to assess the quality of postoperative pain control and success of transition from epidural to oral analgesia in lung transplant recipients. Prospective studies are needed to assess the impact of our findings on patients' outcome.

Acute Disease↗
PubMed2004

Sleep disturbances, pain and analgesia in adults hospitalized for burn injuries.

BACKGROUND AND PURPOSE: Sleep disturbances are frequently reported in hospitalized patients. We have recently shown significant daily relationships between poor sleep and acute burn pain during the first week of hospitalization, where poor sleep leads to reports of higher pain intensity and in return, greater pain affects quality of sleep. This prospective study was designed to objectively evaluate sleep disturbances in hospitalized burn patients and further evaluate their relationships with pain intensity and administered medication. PATIENTS AND METHODS: Sixteen non-ventilated burn patients wore an actigraph (Ambulatory Monitoring, Inc.) during hospitalization (N of 24-h observations 164). Sleep measures included duration and fragmentation (# of awakenings, mean duration of awakenings, mean duration of sleep episodes (MDAW)). Pain intensity was assessed at rest (nighttime, morning, during the day) and following therapeutic procedures known to be painful (e.g. dressing changes). RESULTS: Although sleep duration was extremely variable, patients slept an average of 5.5 h a night with numerous awakenings. During the day, patients often took naps, bringing their total sleep time (TST) to 8 h. Regression analyses showed significant temporal relationships between sleep, pain and analgesic medication such that a night of poor sleep was followed by a significantly more painful day and higher analgesic intake. Further, high levels of pain and analgesic medication during the day were both significant predictors of poor sleep on the following night. CONCLUSIONS: These results obtained with objective measures support previous findings that subjective sleep quality following burn injuries is poor, and strengthen the evidence of a relationship between sleep and sensitivity to pain. Nonetheless, further analyses are necessary to determine and dissociate the effects of pain intensity and analgesic medication on sleep.

Adult↗
PubMed2003

Patient-controlled sedation using propofol for dressing changes in burn patients: a dose-finding study.

The first change of dressings after skin grafting in burn patients is a source of great anxiety because of pain anticipation and the immediate and first confrontation with the result of skin grafting. We designed this dose-finding study to determine the feasibility and safety of patient-controlled sedation (PCS) using propofol during these procedures. Twenty patients were familiarized with the PCS and asked to use PCS whenever they felt uncomfortable or anxious. Analgesia was provided by a single bolus of morphine IV 15 min before the procedure according to their daily intake. The first 10 patients used a fixed bolus of propofol 0.3 mg/kg and a lockout of 5 min. The degree of sedation was measured using bispectral index (BIS) monitoring. Demands versus delivery of propofol boluses were recorded. Within 1 h after the procedure, pain intensity was evaluated and satisfaction scores obtained from patients and nurses performing the dressing changes. In the first 10 patients, there were no respiratory rates <10 breaths/min, systolic and diastolic blood pressure were within 25% of baseline values, and peripheral saturation stayed more than 94% with additional small flow oxygen via nasal insufflation. There were double the demands than actual deliveries of propofol boluses. The BIS did not show significant decreases of <80 in any patient reflecting an insufficient state of sedation. Because the interim analysis of the efficacy of the PCS setup showed an insufficient state of sedation, a different PCS setup was evaluated in a second group of 10 patients (an individualized propofol bolus, titrated to achieve a significant decrease of BIS or a sleepy state, and no lockout period). The second group of patients showed a more effective sedation, with respiratory and hemodynamic variables being not significantly different from the first group of patients. PCS with propofol is feasible in burn patients and can be used safely. To provide an optimal sedation, we suggest to initially titrate the bolus to achieve a significant decrease of BIS or a clinically effective state of sedation and to abolish the lockout interval.

Adult↗
PubMed2002

Incorporation of pain in dreams of hospitalized burn victims.

It has been shown that realistic, localized painful sensations can be experienced in dreams either through direct incorporation or from past memories of pain. Nevertheless, the frequency of pain dreams in healthy subjects is low. This prospective study was designed to evaluate the occurrence and frequency of pain in the dreams of patients suffering from burn pain. Twenty-eight nonventilated burn victims were interviewed for 5 consecutive mornings during the first week of hospitalization. A structured-interview protocol was used to collect information on dream content, quality of sleep, and pain intensity and location. Patients were also administered the Impact of Event Scale to assess posttraumatic symptoms. Thirty-nine percent of patients reported 19 pain dreams on a total of 63 dreams (30%). Patients with pain dreams showed evidence of worse sleep, more nightmares, higher intake of anxiolytic medication, and higher scores on the Impact of Event Scale than did patents reporting dreams with no pain content. Moreover, patients with pain dreams also had a tendency to report more intense pain during therapeutic procedures. Although more than half of our sample did not report pain dreams, these results suggest that pain dreams do occur at a greater frequency in suffering populations than in normal volunteers. More importantly, dreaming about pain may be an added stress for burn patents and may contribute to both poor sleep and higher pain intensity, which could evolve into a cycle of pain-anxiety-sleeplessness.

Adolescent↗
PubMed2002

Intrathecal morphine after cardiac surgery.

OBJECTIVE: To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior pain control after cardiac surgery compared with patient-controlled analgesia (PCA) or nurse-administered SC injections. METHODS: Sixty-two patients undergoing elective cardiac surgery participated in this prospective, randomized, partly-blinded study. Perioperative care was standardized, and patients were assigned to receive IT morphine (ITM group) followed by PCA, IT placebo (ITP group) followed by PCA, or SC injections of morphine every 4 hours as needed (SC group). Rating scales and questionnaires were used to assess clinical outcomes. RESULTS: ITM did not favor earlier extubation, and there was even a tendency for longer extubation times in the ITM group compared with the ITP and SC groups. Pain scores, adverse effects, postoperative recovery, and patient satisfaction were also comparable in the 3 groups. CONCLUSIONS: Considering that the administration of IT morphine is more costly and can be riskier than conventional analgesic regimens, we conclude that its use is not indicated in patients undergoing cardiac surgery if early extubation is planned.

Analgesia, Patient-Controlled↗
PubMed2001

Quality of sleep and its daily relationship to pain intensity in hospitalized adult burn patients.

Sleep disturbances are frequently reported in victims following burn injuries. This prospective study was designed to assess sleep quality and to examine its daily relationship to pain intensity within the first week of hospitalization. Twenty-eight non-ventilated patients were interviewed during 5 consecutive mornings (number of observations=140) to collect information about perceived quality of sleep (visual analogue scale, number of hours, number of awakenings, presence of nightmares). Pain intensity was assessed at rest (nighttime, morning, during the day) and following therapeutic procedures using a 0-10 numeric scale. Seventy-five percent of patients reported sleep disturbances at some point during the study although, in most patients, sleep quality was not consistently poor. Pooled cross-section regression analyses showed significant temporal relationships between quality of sleep and pain intensity such that a night of poor sleep was followed by a significantly more painful day. Pain during the day was not found to be a significant predictor of poor sleep on the following night. These results support previous findings that perceived quality of sleep following burn injury is poor. Moreover, they show a daily relationship between quality of sleep and acute burn pain in which poor sleep is linked to higher pain intensity during the day.

Adolescent↗
PubMed1998

Tactile, thermal and pain sensibility in burned patients with and without chronic pain and paresthesia problems.

Abnormal return of cutaneous sensibility is common after burn injuries and many patients complain of painful and/or paresthetic sensations in their healed wounds. However, little is known about the exact nature and severity of these problems. The present study was designed to provide a quantitative evaluation of the cutaneous sensibility in burned patients. Tactile, thermal and pain thresholds were measured in 121 patients with healed burns paired-matched to 121 control healthy subjects more than 18 months after the burns. Testing was confined to both upper limbs and was performed in a healed burn area and its contralateral burned or unburned counterpart. The tested sites were also divided into symptomatic and asymptomatic ones, depending on the presence or not of pain or paresthesia at the site. The results showed significantly higher sensory thresholds in burned patients than control subjects. Severity of the deficits of the various sensory modalities was, however, a function of burn depth. Deep burn injuries which had required skin grafts to heal were more seriously affected than superficial burns which had healed spontaneously. Significant sensory losses were found not only in burn sites but also in the non-injured areas suggesting changes in the central nervous system. When symptomatic and asymptomatic sites were compared, significant deficits were observed in the tactile modality (touch-pressure). Other significant predictors of chronic sensory problems were burn depth and patients' age. Pathophysiological mechanisms of diminished sensibility in burned and unburned skin as long as several years after the injury are discussed along with those implicated in pain and paresthesia problems reported by the patients.

Adolescent↗
PubMed1990

Comparisons between patients' and nurses' assessment of pain and medication efficacy in severe burn injuries.

In order to provide burn patients with adequate pain relief, the nurses must be able to accurately evaluate the patients' pain levels and to assess whether sufficient analgesia is achieved or not. The present study examined this issue by comparing the pain ratings in 42 patients hospitalized for burn injuries and 42 nurses. The patient and the attending nurse were asked to rate, independently of each other, the intensity of the pain felt by the patient during a therapeutic procedure and at rest. When analgesic medication was given prior to the procedure, both the patients and the nurses were asked to estimate the degree of pain relief. All ratings were obtained using visual analogue and verbal scales. The results revealed significant but small correlations between the nurses' and patients' ratings. Frequently, the nurses underestimated or overestimated the patients' pain. Discrepancies were also observed in the evaluation of pain medication efficacy, the nurses showing a tendency to overestimate the degree of pain relief. The accuracy of the nurses' perception did not vary as a function of the patients' age, socioeconomic status or burn severity. However, the number of years of experience in burn-nursing had a significant influence on the nurses' estimation of the patients' pain during therapeutic procedures. Theoretical and clinical implications of these results are discussed with a particular emphasis on the need to implement systematic procedures to assess pain and success of analgesia. Additional recommendations to optimize pain management in burn patients are also made.

Adolescent↗
PubMed1987

Acute and chronic pain in hemophilia.

The present study compared acute vs. chronic pain in hemophiliac subjects who suffer both types of pain. Characteristics of the acute pain produced by a hemorrhage into a joint and the chronic arthritic pain that results from repeated bleeding episodes were assessed with the McGill Pain Questionnaire and a visual analogue pain intensity scale. The results showed a high degree of similarity in the sensory, affective and evaluative properties of the two types of pain. The main difference between the acute and chronic pains was one of overall intensity, with the acute pain generally being described as more intense. A comparison of the arthritic pain in hemophilia with the pain of other arthritic disorders revealed no major differences. Sources of inter-individual variability were also explored and the results showed that the pain scores in hemophiliac subjects were largely unrelated to demographic and pain history variables. However, significant differences were observed in the way French- and English-speaking subjects described and rated their pain. Irrespective of the origin of their pain, French-speaking subjects characteristically rated their pain as more intense and more affectively laden than the English group. These results demonstrate that ethnocultural factors associated with language affiliation may contribute to inter-individual variation in pain perception.

Acute Disease↗
PubMedDate not supplied

The treatment of chronic pain in Québec: a study of hospital-based services offered within anesthesia departments.

PURPOSE: Little or no information exists on the services that are currently available for the treatment of chronic pain across the different regions of Canada. As a first step, this study documented the hospital-based resources and services offered for the management of chronic non-cancer pain within anesthesia departments in Québec. METHODS: In collaboration with the Association of Anesthesiologists of Québec and the Société québécoise de la douleur, a provincial survey was conducted to assess the availability of services for chronic pain management within hospital-based anesthesia departments along with the volume of clinical activities, staff composition, treatments offered and space facilities. RESULTS: The response rate was 100%. Fifty of the 69 departments (73%) offered services for the management of chronic non-cancer pain but the services were often limited. Twenty-six percent (13/50) of the departments provided some form of multidisciplinary assessment and treatment but only three had a core team comprised of an anesthesiologist, a nurse, a psychologist, and a physical therapist. Examination of patient waiting lists of the surveyed departments revealed disturbing results: approximately 4,500 patients were waiting for their first appointment to see a pain consultant, and nearly 3,000 (67%) had been waiting for nine months or more. CONCLUSION: Although this survey did not include the services offered in departments other than anesthesia, the results show the extent to which the province of Québec is under-resourced for the management of chronic pain patients both in terms of access to treatment and quality of the services offered.

Anesthesia Department, Hospital↗
PubMedDate not supplied

Management of chronic neuropathic pain with methadone: a review of 13 cases.

The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly neuropathic pain. Unfortunately, the evidence for its use in the management of neuropathic pain is limited to a few case studies. We examined retrospectively during a 12-month study period the clinical response of all 13 patients at our pain clinic who were prescribed methadone in an attempt to control neuropathic pain resistant to conventional analgesics. A questionnaire was also administered to the 9 patients who continued to take methadone at 12 months posttreatment. A total of 4 patients (31%) discontinued it by the end of the 12-month study period. Patients discontinued methadone due to the absence of pain relief and due to various intractable, undesirable side effects. Somnolence was the most common adverse effect reported, followed by nausea, constipation, and vomiting. All patients took coanalgesics (eg, amitriptyline, gabapentin) or other analgesics (eg, morphine, nonsteroidal anti-inflammatory drugs) during methadone treatment to control pain. The 9 patients who continued to take methadone at 12 months reported experiencing on average 43% pain relief (range 0-80%), 47% improvement in quality of life (range 0-100%), and 30% improvement in quality of sleep (range 0-60%). Methadone was effective at relieving pain and ameliorating quality of life and sleep in 62% of patients. These findings suggest that methadone can offer an acceptable success rate for the treatment of neuropathic pain. Prospective randomized, placebo-controlled studies are now needed to examine more rigorously the benefits of methadone for this type of pain.

Adult↗