One of the most important cause of postoperative morbidity is insufficiently treated pain. Patient undergoing spinal surgery often suffer from severe preoperative pain and may require large doses of analgesic drugs including opioids. Longer-lasting, preoperative or chronic pain of greater intensity, patients with 'failed back syndrome' have been identified to cause problems towards control of postoperative pain. Because neurologic examination to detect spinal cord complications requiring immediate intervention are based upon patient cooperation and awareness, different modalities for postoperative pain treatment and a choice of drugs from various classes of analgesics may be effective in these circumstances. Overall, moderate to severe postoperative pain has been correlated with an increased risk for the development of persistent, chronic pain states. These problems may be prevented by successful management of postoperative pain. Acute postoperative pain management is a dynamic process. A detailed preoperative assessment should be done at the beginning and the most appropriate pain management should be provided by utilizing the newer drugs and techniques after estimation of risk-benefit status for each patient.

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Background: One of the most common complaints of the patient seeking medical care is pain, and it has been recognized by the World Health Organization as a problem of global importance. Objectives: The aim was to estimate the prevalence of pain among people above the age of 40 years, to identify the common sites of pain complaints and to study the association of body mass index (BMI) with musculoskeletal pains. Materials and Methods: A cross-sectional study was carried out among 1246 participants through our weekly medical camp in 12 villages of Kattankulathur block in Kancheepuram District of Tamil Nadu from August 2013 to October 2013. Individuals over the age of 40 years who had attended our medical camp with complaint of pain (intermittent or continuous) for 1 month or longer were included in the study. Descriptive data were presented as measures of central tendency and dispersion. Chi-square test was used for analyzes of categorical variables. Results: Nearly 51.1% of the respondents reported some form of pain. The prevalent sites of pain include knee pain (18.6%), low back pain (8.9%), generalized body pain (7.8%), multiple joint pain (4.9%) and pain in the legs (2.7%). Prevalence of musculoskeletal pain in men and women were 32.7% and 53.7%, respectively. Respondents with BMI more than 25 are at higher risk of suffering from knee pain, hip pain, low back pain and leg pain and it was found statistically significant for Knee pain and low back pain. Conclusion: An appropriate strategy and guidelines have to be developed to manage the problem of pain among above 40 years age group at primary care level of the rural communities in India.

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Burning mouth syndrome (BMS) is characterized by an oral burning sensation in the absence of any organic disorders of the oral cavity. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. It is observed principally in middle-aged patients and postmenopausal women and is characterized by an intense burning type of pain, preferably on the tongue and in other areas of the oral mucosa. As the symptom of oral burning is seen in various pathological conditions, it is essential for a clinician to be aware of how to differentiate between symptom of oral burning and BMS. This article provides an overview of the literature on this syndrome with special reference to the etiological factors, clinical aspects, diagnostic criteria that should be followed and the therapeutic management with reference to the most recent studies.

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Introduction and Aims: Pain is a common debilitating symptom of cancer cervix. It occurs in 25-50% patients with newly diagnosed malignancies and in more than 75% of those with advanced disease. Yet, it is one of the most unattended problem. Henceforth, this study was planned to assess pain and to evaluate the response to pain management according to WHO step ladder protocol in cases of cancer cervix. Materials and Methods: This was a prospective cohort study that included patients of cancer cervix with pain. Patients of cancer cervix with severe systemic debilitating illness and those who had undergone major surgery in past 2 weeks were excluded from the study. The severity of pain was assessed by using visual analogue scale. Pain was managed according to WHO step ladder protocol for pain. Result: Total 61.5% patients of cancer cervix presented with pain. Success rate of WHO pain management protocol was 95.3%. Conclusion: Pain management was done effectively using WHO guided step ladder pain management protocol in 95.3% of cases. Oral Morphine is an effective drug for pain management. It is easily titratable and has a favorable benefit to risk ratio.

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Context: The school age children face daily responsibility of carrying variety of items to and fro and also around school. "Back pain" is currently emerging as a major health problem among school age group children, which can limit their daily activities. Aim: The aim was to investigate the factors that reflect the prevalence of back pain among school age group children, with particular attention on the weight of backpacks' mode of transportation to school. Materials and Methods: A total of 626 children are registered for this study between the age group of 12-16 years. They are weighed twice on the digital scale; the first time with their backpacks on and the second time without any backpacks. Questionnaire made and used to determine the presence and severity of back pain; data analyzed and descriptive statistics and multimonial regression analysis are performed to investigate the reflection of certain factors like gender, school bag carrying method, bag weight to student weight ratio, mode of transportation etc. on the occurrence of back pain. Odds ratio (OR) obtained from the analysis are used to compare the different levels of the same factor for relative occurrence of back pain. Results: Of 626 students; 172 are female, and 454 are male; 318 (50.7%) carried backpacks weighing 10-15% of their body weight. Among 626 students, 358 (57.1%) are reported to have back pain, 12.6% students required physician's visit and 18.6% students missed school because of back pain. Students carrying more than 15% of their body weight are found to have higher risk of back pain with (odds ratio = 4.3459 confidence interval = 95% 2.63-7.169, P = 0.0001). 425 students are reported to have walked to school with their backpacks on, out of which 260 (61.17%) are reported with back pain; significant association with P = 0.0004 is found among these subjects who walked to school with their back packs on. Conclusion: Carrying heavy backpacks increases the relative risk of back pain among school age group children, and prevalence of these children are found to be extremely high. Therefore, preventive and educational activities must be implemented among these school age group children.

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Nonspecific persistent and chronic low back pain (LBP) is one of the world's most significant burdens. Its management continues to be challenging despite advancements in medical diagnostics and therapeutics. The purpose of this narrative review is to update evidence-based, multidisciplinary assessment and treatment strategies for nonspecific non-acute LBP with special emphasis on the growing influence of psychological principles in physiotherapists' (PT) practice. An electronic literature search was performed to identify relevant clinical practice guidelines, from which an overarching summary was synthesized. All guidelines were consistent in their recommendations for the assessment of psychosocial factors and psychology-based interventions. In discussion, we underlined psychological processes and psychology-based strategies that are clinically relevant to, and within the professional competency and scope of PT practice.

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Background and Aims: Brachial plexus block is close to the ideal anesthetic technique for upper limb surgeries. Several clinical studies have shown that clonidine prolongs sensory motor blockade when used with bupivacaine but effect of clonidine on ropivacaine is not well defined. Present study was done to evaluate the effect of clonidine 2 μg/kg added to ropivacaine 0.5% in supraclavicular brachial plexus block. Methods: In this prospective, randomized, double blind study total 80 patients of American society of anesthesiologist, (ASA) grade I and II undergoing elective upper limb surgery under supraclavicular brachial plexus block were randomized into two groups. Patients in group 1 (n = 40) received 28 ml of 0.5% ropivacaine and in group 2 (n = 40) received 28 ml of 0.5% ropivacaine with clonidine (2 μg/kg body weight). Onset and recovery time of sensory and motor block, duration of analgesia and quality of block, hemodynamic variables, oxygen saturation and level of sedation were studied in both the groups. All the data were analyzed by using unpaired t test. P < 0.05 was considered significant. Result: Sensory and motor block onset times were similar in both the groups. The mean duration of analgesia was 1016.92 + 170.14 min and mean duration of motor block was 880.54 + 127.99 min in group 2. On comparing both the groups it was found statistically significant (P < 0.000). In group 2 four patients showed mild sedation. Group1 showed more severity of pain than group 2 and it was found to be statistically significant (P < 001). Conclusion: Clonidine 2 μg/kg body weight when added to 0.5% ropivacaine in supraclavicular brachial plexus block significantly prolonged sensory and motor block and provides better post-operative analgesia.

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Headaches have become relatively less prevalent in older patients, but still more than fifty percent of people older than 65 years complain about regularly occurring headache. Most of the headaches are primary headaches. Common chronic headache in elderly population include migraine, cluster headache, tension-type headache, and chronic daily headache. The crux of headache management is diagnosis and preventive therapy rather than treating acute attacks. However, diagnostic interventions in geriatric patients do not differ from those in younger headache patients. Although, there is paucity of literature on headache in this special population, we have tried to review the understanding and management of common chronic headache in elderly population.

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This report will present two cases of epidural abscesses following pain interventions and review available evidence and provide preventive strategies for its avoidance. A 54-year-old man having chronic low back and leg pain with past history significant for alcohol dependence and lumbar spine surgeries received a caudal epidural steroid injection following multiple intravascular injection of contrast. Eleven days following the procedure he developed symptoms suggestive of epidural abscess. It was subsequently confirmed by magnetic resonance imaging (MRI) and underwent nonsurgical management of the abscess without any neurological deficit. A 50-year-old homeless man with history of intravenous drug abuse, alcohol abuse, hepatitis C positive, squamous cell carcinoma of the neck, and degenerative lumbar disc disease received trigger point injections to his lumbar paraspinal muscles for management of his myofascial pain syndrome. Fifteen days following the injection, he reported to the emergency (ER) room with complaints of worsening pain. An MRI revealed epidural; abscesses tracking from the paraspinal muscles. He was subsequently managed with intravenous antibiotics and recovered uneventfully. Following review of the literature, it is possible to come up with preventive strategies to mitigate the occurrence of epidural abscesses. One of the key factors is the presence of comorbid conditions including diabetes mellitus and prior spine surgery which may dictate technique for the management of pain.

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A 12-year-old ASA I female patient underwent correction of posterior scoliosis of dorsolumbar spine under total intravenous anesthesia using a combination of remifentanil and propofol. Induced hypotension was maintained between 55 and 65 mmHg. Intraoperatively, patient received a single injection of 1.0 g paracetamol. Surgery lasted 6 h and 40 min and was essentially uneventful. A follow-up investigation in the intensive care unit 6 h after the surgery revealed alanine transaminase levels of 547 I/U. This increased to 924 I/U on the 2 ^nd postoperative day after the patient received 500 mg per-rectal paracetamol. Stopping administration of paracetamol restored alanine transaminase level to normal without needing N-acetylcysteine.

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