Local Active Warming: An Effective Treatment for Pain, Anxiety and Nausea Caused by Renal Colic

Kober, Alexander; Dobrovits, Michael; Djavan, Bob; Marberger, Michael; Barker, Renate; Bertalanffy, Petra; Scheck, Thomas; Gustorff, Burkhard; Hoerauf, Klaus

doi:10.1097/01.ju.0000080570.83834.ad

Cited by 51 publications

(36 citation statements)

References 16 publications

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“…With data from previous studies [15][16][17][18], 16 patients per group were calculated to allow identification of a clinically relevant effect of skin surface warming on anxiety (a decrease of 20 on an anxiety VAS 100 scale) with a power of 80%.…”

Section: Discussionmentioning

confidence: 99%

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The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

2007

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SummarySkin surface warming of patients not only improves thermal comfort, but has been shown to reduce anxiety in a pre-hospital setting. We tested the hypothesis that pre-operative warming can reduce pre-operative anxiety as effectively as a conventional dose of intravenous midazolam in patients undergoing neurosurgery. We randomly allocated 80 patients to four groups in the pre-operative holding area. Treatment was applied for 30-45 min with (1) passive insulation and placebo; (2) passive insulation and intravenous midazolam (30 lg.kg )1 ); (3) warming with forced-air and placebo; and (4) warming with forced-air and intravenous midazolam (30 lg.kg )1 ). Thermal comfort levels (VAS 0-100 mm) and anxiety levels (VAS 0-100 mm, Spielberger State-Trait Anxiety Inventory) were assessed twice: before the designated treatment was started and before induction of anaesthesia. In the midazolam and the midazolam ⁄ warming groups, anxiety VAS and Spielberger state anxiety scores decreased by ) 19 (95% CI: ) 29 to ) 9, p < 0.01) and ) 10 (95% CI: ) 14 to ) 6, p < 0.01), respectively. In the warming and the combined groups, thermal VAS increased by + 26 (95% CI: 17-34, p < 0.01). [7], and prolonged hospitalisation [5]. Pre-operative warming before induction can prevent redistribution hypothermia and can improve thermal comfort by keeping the patient warm during the preoperative period [8,9]. This benefit of pre-operative warming has been demonstrated in several studies during regional [10] and general anaesthesia [8,11,12]. The administration of pre-operative warming has even been shown to abolish completely the need for any additional intra-operative warming in certain patient populations [13,14].There is, however, another potential benefit of preoperative warming: it may reduce anxiety. In four recent studies, minor trauma victims [15], patients with lower back pain [16], patients with renal colic [17] and cholelithiasis pain [18] were assigned to passive insulation or carbon-fibre warming: The warmed patients had improved thermal comfort, less pain, and were significantly less anxious.For the reduction of pre-operative anxiety, patients typically receive medications such as oral or intravenous benzodiazepines, yet these medications are not always effective and can be associated with respiratory depression and delayed discharge [19][20][21][22][23]. Thus, several non-pharmacological methods to reduce pre-operative anxiety have been considered, including music therapy [24,25], supply of in-depth information with leaflets [26] or videos

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Section: Discussionmentioning

confidence: 99%

“…Previous studies investigated the role of warming during emergency transport for minor trauma, renal colic and cholelithiasis pain, and acute low back pain [15][16][17][18]. Besides significant pain reduction, these studies reported that warming markedly reduced anxiety.…”

Section: Discussionmentioning

confidence: 99%

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

2007

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“…One randomized, prospective trial demonstrated that the pain from renal colic may be reduced by wrapping the patient's abdomen in a resistive heating blanket set to 42°C. 22 Acupuncture may also reduce pain, but it has not been compared directly with commonly used medications. 23 Because the pain is due to renal capsular distention, intractable pain is controlled by decompressing the obstruction.…”

Section: Pain and Nauseamentioning

confidence: 99%

Acute Renal Colic from Ureteral Calculus

Teichman¹

2004

N Engl J Med

325

182

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The new england journal of medicine n engl j med 350;7 www.nejm.org february 12, 2004 684 This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.A 39-year-old man reports an eight-hour history of colicky pain in the right lower quadrant radiating to the tip of his penis. He had previously had a kidney stone, which passed spontaneously. Physical examination shows that he is in distress, is afebrile, and has tenderness of the right costovertebral angle and lower quadrant. Urinalysis shows microhematuria. Helical computed tomography (CT) of the abdomen and pelvis shows a 6-mm calculus of the right distal ureter and mild hydroureteronephrosis. How should this patient be treated?Up to 12 percent of the population will have a urinary stone during their lifetime, and recurrence rates approach 50 percent. 1 In the United States, white men have the highest incidence of stones, followed in order by white women, black women, and black men. 2,3 Fifty-five percent of those with recurrent stones have a family history of urolithiasis, 4 and having such a history increases the risk of stones by a factor of three. 5The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin. As the stone descends in the ureter, the pain may localize in the abdominal area overlying the stone and radiate to the gonad. Peritoneal signs are absent. As the stone approaches the ureterovesical junction (Fig. 1), lower-quadrant pain radiating to the tip of the urethra, urinary urgency and frequency, and dysuria are characteristic, mimicking the symptoms of bacterial cystitis. Physical examination typically shows a patient who is often writhing in distress, trying to find a comfortable position. Tenderness of the costovertebral angle or lower quadrant may be present. Gross or microscopic hematuria occurs in approximately 90 percent of patients; however, the absence of hematuria does not preclude the presence of stones. 6 Owing to the shared splanchnic innervation of the renal capsule and intestines, hydronephrosis and distention of the renal capsule may produce nausea and vomiting. Thus, acute renal colic may mimic acute abdominal or pelvic conditions. diagnosisThe best imaging study to confirm the diagnosis of a urinary stone in a patient with acute flank pain is unenhanced, helical CT of the abdomen and pelvis (Fig. 1). 7 In a prospective trial of 106 adults with acute flank pain, all patients underwent both unenhanced helical CT and intravenous urography (the previous gold standard), 8 and the results of each were interpreted separately and in a blinded fashion by a radiologist. Seventy-five patients received a diagnosis of ureteral stones. The sensitivity of CT was 96 percent, as compared with 87 percent for urography, and the respective specificities were 100 percent and 94 percent (P<0.001 for both compar...

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“…There is also some recent published evidence indicating that warming might be helpful in clinical practice. Kober and colleagues showed, in two different reports, that local abdominal active warming (with an electric heating blanket set to 42 • C) is effective in alleviating pain resulting from acute cholelithiasis (29), and for pain, anxiety, and nausea caused by renal colic (30), in emergency care. Other studies showed positive effects of warming on cardiac pain (31), and also there seems to be some evidence for using warming in the treatment of menstrual discomfort in young women (32).…”

Section: Discussionmentioning

confidence: 99%

Effect of Moxibustion at Acupoints Ren-12 (Zhongwan), St-25 (Tianshu), and St-36 (Zuzanli) in the Prevention of Gastric Lesions Induced by Indomethacin in Wistar Rats

et al. 2005

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This study was aimed at assessing the physical characteristics underlying the action of moxibustion at acupoints Ren-12 (Zhongwan), St-25 (Tianshu), and St-36 (Zuzanli) in preventing acute injuries of the gastric mucous membrane induced by indomethacin in Wistar rats. Induction of gastric lesions, by means of intragastric administration of indomethacin (100 mg/kg), in adult male Wistar rats was followed by treatment with moxibustion using Artemisia vulgaris dried leaves at 60 or 45 degrees C, heating with Artemisia vulgaris charcoal at 50 degrees C, heating with a regular tobacco cigar at 50 degrees C, and heating with a regular water pad at 50 degrees C, The effects of the different heating protocols over the gastric lesions were then compared. In addition, another group of animals was pretreated with capsaicin (100 mg/kg, s.c.), in order to lesion C fibers and, 15 days later, subjected to indomethacin administration and moxibustion treatment. Moxibustion was significantly more efficient at 60 degrees C than at 45 degrees C in preventing gastric lesions triggered by indomethacin. Moxibustion applied in acupoints provided a significant reduction of the lesion area, which was two times less than that of animals stimulated in a nonacupoint (sham group). Comparing the therapeutic effects provided by different forms of heating over the gastric lesions, the burning of dry leaves of Artemisia vulgaris was significantly more efficient in preventing gastric lesions than moxibustion made with Artemisia charcoal or tobacco (cigar) or by heating the animal with a water pad. Desensitization of the afferent sensory C fibers by capsaicin significantly diminished the ability of moxibustion to block the lesions in the gastric mucous membrane. Moxibustion can efficiently prevent indomethacin-induced gastric lesions in rats and this effect is dependent on the temperature, the material used for moxibustion, the use of acupuncture points, and the integrity of C fibers.

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Local Active Warming: An Effective Treatment for Pain, Anxiety and Nausea Caused by Renal Colic

Abstract: Local active warming is an effective and easy to learn pain treatment for patients with acute renal colic in emergency care.

Cited by 51 publications

References 16 publications

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

Acute Renal Colic from Ureteral Calculus

Effect of Moxibustion at Acupoints Ren-12 (Zhongwan), St-25 (Tianshu), and St-36 (Zuzanli) in the Prevention of Gastric Lesions Induced by Indomethacin in Wistar Rats

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