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946 A META-ANALYSIS OF QUALITATIVE RESEARCH ON PATIENTS' EXPERIENCES OF CHRONIC PAIN
Topic G: DIAGNOSIS, ASSESSMENT AND REVIEWS Fifty-seven papers were initially identified: impact of education (N = 28), influence of Doctors characteristics (N = 5), influence of patient’s expectations (N = 8) and satisfaction (N = 4), interpersonal relationship with the Doctor (N = 4), Doctors perception of the patients’ pain (N = 5) and external factors e.g. employers (N = 3). Doctor’s attitudes and beliefs have important health and financial implications for both the patient and the health service. The findings of this systematic review will inform a national survey of medical practitioners’ attitudes to LBP. 945 REFLEX SYMPATHETIC DYSTROPHY SYNDROME OF THE LOWER EXTREMITY AFTER SPINAL CORD INJURY (CASE REPORT) A. Kurtaran ° , B. Sel¸cuk, N. Sulubulut, M. Aky¨uz, M. Ers¨oz. Ankara Fizik Tedavi Ve Rehabilitasyon Egitim Ve ArastıRma Hastanesi, Ankara, Turkey Background and Aims: Reports of SCI patients with RSDS are rare and most of these reported cases involve upper extremities in tetraplegic patient. Our case, presents and discusses a patient with RSDS involving lower extremity. Method: A 31 year old female patient presented herself with bladder and rectal dysfunction, difficulty walking and leg pains. Patient was involved in a car accident two months prior to symptoms and diagnosed with a L-1 vertebral burst fracture. Both lower extremity joints had free movement capability but, left extremity had edema, hyperemia and pain on palpation at the dorsal side of the foot and pain by motion or palpation at the knee. Related to the patients painful picture, to differentiate the diagnosis from deep vein thrombosis (DVT), heterotopic ossifications (HO), RSDS and stress fractures, direct bone graphies, Doppler ultrasonography, three phasic radionuclide syntigraphy of the involved bones, were requested. Three phasic radionuclide syntigraphy also revealed increased activity compatible with RSDS at left knee and foot. Whirlpool and massage to this extremity was initiated and calcitonin 100 IU/24h IM was started. Conclusions: As being a rarely seen problem, our case which is similar to the other reported rare cases of post MSI lower extremity RSDS, once again reinstates the importance to consider this syndrome among the other diseases with similar symptoms within this group of patients, careful evaluation of other possible causes and early, aggressive treatement of the problem for a complete remission and prevention of permanent complications might later develop.
946 A META-ANALYSIS OF QUALITATIVE RESEARCH ON PATIENTS’ EXPERIENCES OF CHRONIC PAIN A. Willman1 , B. Sj¨ostr¨om2 ° . 1 School of Health Science, Blekinge Institute of Technology, Karlskrona, 2 University of Sk¨ovde, School of Life Sciences, Sk¨ovde, Sweden Aim: To make a meta-analysis of research with qualitative methods on patients’ experiences of chronic pain. Methods: A systematic search in Medline and CINAHL in February, 2003, identified studies concerning patients experiences of chronic pain. Patients with back pain, abdominal pain, cancer pain, migraine or postoperative pain were excluded. All together, 154 full-text documents were analysed in two steps. First they were all assessed for quality and scientific rigor after a specific developed assessment tool. Secondly, results from studies ranking high and medium in scientific quality, and with similar methodological point of departure, were categorised using a classical inductive, qualitative research approach. Results: The results from the analysis show that there are five main areas, which characterizes problematic areas for patients suffering from chronic pain. These areas are: The painful body with the principal themes: Pain in itself, Fatigue and Sleep disturbances. The second main area is The search to reduce suffering with the themes: Self-control, Medicine and Diagnosis. The third is: Struggling for dignity with the themes: Loss of freedom, Loss
S245 of integrity and Existence. The fourth is The imposed reorientation and the fifth is Mediation of the experience of suffering from chronic pain. Conclusions: The findings suggest that the patients’ experiences of chronic pain are focused on the pain itself but also on the consequences of longterm pain for human living. It is of utmost importance that professionals are able to take into account the individual patient’s experiences and integrate this with previous professional experience. G08 PAIN EPIDEMIOLOGY 947 CRANIOMANDIBULAR DISARTICULATION, A HIDDEN CAUSE FOR COMPLEX HEAD AND NECK PAIN AND DISORDERS R.A. Abdel-Fattah ° , M.M. Alattar. Private Practice, Boca Raton FL, USA The human mandible has a unique mechanical position located underneath the maxilla, a bone that is attached to the cranium and influence the function of the cranial bones. Distorted Craniomandibular articulation causes undue pressure and eventually symptoms such as persistent unexplained headache, earache, sinus-like pain, pain behind eyes]and dysfunction such as limitation of movement, difficult mastication, or disfigurement. In addition, the mandible is positioned anterior and superior to the cervical region influencing the Oropharynx that has vital live essential functions such as respiration, deglutition, and posture. Posterior mandibular displacement may be a causative factor in snoring, obstructive sleep apnea, unusual throat pain, difficult swallowing and or unrelenting neck pain, Unfortunately the assessment of the mandibular balance is not usually implemented in the neurological, orthopedic, or Otorhinolaryngological examinations. A short examination methods together with the needed diagnostic testing as well as some complex cases are to be presented.
948 HERBAL DRUGS AND DYSMENOREA P. Afshari ° , S. Sadeghi, F. Pazandeh. Nursing and Midwifery Faculty, Ahvaz Jondishapour Medical Sciences University, Ahvaz, Khozestan, Iran
Introduction: Painful menstruation is a cyclic painful condition that adversely affects the woman’s wellbeing for a large part of her life. Medication is usually required for all cases of moderate to severe painful menstruation. Apart from pharmacological agents, several techniques have been used including relaxation therapy, hypnosis, manipulation, psychotherapy, acupuncture, biofeedback techniques, and also using of herbal drugs the aim of this study was to determine frequency use of herbal drugs in university students. Material and Method: It was a descriptive study. We studied 215 female students in university in reproductive age (19−22 yrs). Data was collected through a self-administered questionnaire. Results: We found that the mean age of students were 20 yrs old. 24% of students use from herbal drugs. The most common drugs that they used were Carun carvi and Zataria multiflora boiss. They believed that medical drugs reduce their bleeding and it shows that may be having other side effects. All of the students believed that herbal drugs can reduce their pain as well as synthetic drugs. Conclusion: Herbal drugs can use for relief menstruation pain and educated and young people believed its benefits but we must tell them this drugs have side effect too.
946 A META-ANALYSIS OF QUALITATIVE RESEARCH ON PATIENTS’ EXPERIENCES OF CHRONIC PAIN A. Willman1 , B. Sj¨ostr¨om2 ° . 1 School of Health Science, Blekinge Institute of Technology, Karlskrona, 2 University of Sk¨ovde, School of Life Sciences, Sk¨ovde, Sweden Aim: To make a meta-analysis of research with qualitative methods on patients’ experiences of chronic pain. Methods: A systematic search in Medline and CINAHL in February, 2003, identified studies concerning patients experiences of chronic pain. Patients with back pain, abdominal pain, cancer pain, migraine or postoperative pain were excluded. All together, 154 full-text documents were analysed in two steps. First they were all assessed for quality and scientific rigor after a specific developed assessment tool. Secondly, results from studies ranking high and medium in scientific quality, and with similar methodological point of departure, were categorised using a classical inductive, qualitative research approach. Results: The results from the analysis show that there are five main areas, which characterizes problematic areas for patients suffering from chronic pain. These areas are: The painful body with the principal themes: Pain in itself, Fatigue and Sleep disturbances. The second main area is The search to reduce suffering with the themes: Self-control, Medicine and Diagnosis. The third is: Struggling for dignity with the themes: Loss of freedom, Loss
S245 of integrity and Existence. The fourth is The imposed reorientation and the fifth is Mediation of the experience of suffering from chronic pain. Conclusions: The findings suggest that the patients’ experiences of chronic pain are focused on the pain itself but also on the consequences of longterm pain for human living. It is of utmost importance that professionals are able to take into account the individual patient’s experiences and integrate this with previous professional experience. G08 PAIN EPIDEMIOLOGY 947 CRANIOMANDIBULAR DISARTICULATION, A HIDDEN CAUSE FOR COMPLEX HEAD AND NECK PAIN AND DISORDERS R.A. Abdel-Fattah ° , M.M. Alattar. Private Practice, Boca Raton FL, USA The human mandible has a unique mechanical position located underneath the maxilla, a bone that is attached to the cranium and influence the function of the cranial bones. Distorted Craniomandibular articulation causes undue pressure and eventually symptoms such as persistent unexplained headache, earache, sinus-like pain, pain behind eyes]and dysfunction such as limitation of movement, difficult mastication, or disfigurement. In addition, the mandible is positioned anterior and superior to the cervical region influencing the Oropharynx that has vital live essential functions such as respiration, deglutition, and posture. Posterior mandibular displacement may be a causative factor in snoring, obstructive sleep apnea, unusual throat pain, difficult swallowing and or unrelenting neck pain, Unfortunately the assessment of the mandibular balance is not usually implemented in the neurological, orthopedic, or Otorhinolaryngological examinations. A short examination methods together with the needed diagnostic testing as well as some complex cases are to be presented.
948 HERBAL DRUGS AND DYSMENOREA P. Afshari ° , S. Sadeghi, F. Pazandeh. Nursing and Midwifery Faculty, Ahvaz Jondishapour Medical Sciences University, Ahvaz, Khozestan, Iran
Introduction: Painful menstruation is a cyclic painful condition that adversely affects the woman’s wellbeing for a large part of her life. Medication is usually required for all cases of moderate to severe painful menstruation. Apart from pharmacological agents, several techniques have been used including relaxation therapy, hypnosis, manipulation, psychotherapy, acupuncture, biofeedback techniques, and also using of herbal drugs the aim of this study was to determine frequency use of herbal drugs in university students. Material and Method: It was a descriptive study. We studied 215 female students in university in reproductive age (19−22 yrs). Data was collected through a self-administered questionnaire. Results: We found that the mean age of students were 20 yrs old. 24% of students use from herbal drugs. The most common drugs that they used were Carun carvi and Zataria multiflora boiss. They believed that medical drugs reduce their bleeding and it shows that may be having other side effects. All of the students believed that herbal drugs can reduce their pain as well as synthetic drugs. Conclusion: Herbal drugs can use for relief menstruation pain and educated and young people believed its benefits but we must tell them this drugs have side effect too.