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Johnson MI. Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:378. [PMID: 33919821 PMCID: PMC8070828 DOI: 10.3390/medicina57040378] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 12/26/2022]
Abstract
Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to 'electrically rubbing pain away'. Despite over 50 years of published research, uncertainty about the clinical efficacy of TENS remains. The purpose of this comprehensive review is to critically appraise clinical research on TENS to inform future strategies to resolve the 'efficacy-impasse'. The principles and practices of TENS are described to provide context for readers unfamiliar with TENS treatment. The findings of systematic reviews evaluating TENS are described from a historical perspective to provide context for a critical evaluation of factors influencing the outcomes of randomized controlled trials (RCTs); including sample populations, outcome measures, TENS techniques, and comparator interventions. Three possibilities are offered to resolve the impasse. Firstly, to conduct large multi-centered RCTs using an enriched enrolment with randomized withdrawal design, that incorporates a 'run-in phase' to screen for potential TENS responders and to optimise TENS treatment according to individual need. Secondly, to meta-analyze published RCT data, irrespective of type of pain, to determine whether TENS reduces the intensity of pain during stimulation, and to include a detailed assessment of levels of certainty and precision. Thirdly, to concede that it may be impossible to determine efficacy due to insurmountable methodological, logistical and financial challenges. The consequences to clinicians, policy makers and funders of this third scenario are discussed. I argue that patients will continue to use TENS irrespective of the views of clinicians, policy makers, funders or guideline panel recommendations, because TENS is readily available without prescription; TENS generates a pleasant sensory experience that is similar to easing pain using warming and cooling techniques; and technological developments such as smart wearable TENS devices will improve usability in the future. Thus, research is needed on how best to integrate TENS into existing pain management strategies by analyzing data of TENS usage by expert-patients in real-world settings.
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Affiliation(s)
- Mark I Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK
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Kojic K, Clarke H. Important considerations with respect to reducing the transition from acute to persistent postoperative pain. Expert Opin Pharmacother 2021; 22:779-782. [PMID: 33634743 DOI: 10.1080/14656566.2021.1892073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katarina Kojic
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Transitional Pain Service, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
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El-Tallawy SN, Nalamasu R, Salem GI, LeQuang JAK, Pergolizzi JV, Christo PJ. Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain Ther 2021; 10:181-209. [PMID: 33575952 PMCID: PMC8119532 DOI: 10.1007/s40122-021-00235-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/09/2021] [Indexed: 12/28/2022] Open
Abstract
Musculoskeletal pain is a challenging condition for both patients and physicians. Many adults have experienced one or more episodes of musculoskeletal pain at some time of their lives, regardless of age, gender, or economic status. It affects approximately 47% of the general population. Of those, about 39–45% have long-lasting problems that require medical consultation. Inadequately managed musculoskeletal pain can adversely affect quality of life and impose significant socioeconomic problems. This manuscript presents a comprehensive review of the management of chronic musculoskeletal pain. It briefly explores the background, classifications, patient assessments, and different tools for management according to the recently available evidence. Multimodal analgesia and multidisciplinary approaches are fundamental elements of effective management of musculoskeletal pain. Both pharmacological, non-pharmacological, as well as interventional pain therapy are important to enhance patient’s recovery, well-being, and improve quality of life. Accordingly, recent guidelines recommend the implementation of preventative strategies and physical tools first to minimize the use of medications. In patients who have had an inadequate response to pharmacotherapy, the proper use of interventional pain therapy and the other alternative techniques are vital for safe and effective management of chronic pain patients.
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Affiliation(s)
- Salah N El-Tallawy
- Anesthesia and Pain Management Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Faculty of Medicine, Minia University and NCI, Cairo University, Cairo, Egypt.
| | - Rohit Nalamasu
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gehan I Salem
- Rheumatology, Rehabilitation and Physical Medicine Department, Assiut University Hospital, Assiut, Egypt.,Rehabilitation Medicine Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Paul J Christo
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tovar-Gutiérrez A, Camelo-Rincón JE, Vásquez-Gómez ÓI, Cadavid-Puentes AM. Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hip fracture pain is frequently acute and disabling and increases perioperative complications in the patient; hence it requires a multimodal analgesia approach. This case series describes the continuous erector spinae plane block at the lumbar level for hip fracture analgesia.
Methods: A search was conducted of patients with hip fracture referred to the pain service of Hospital Universitario San Vicente Fundación (HUSVF) from August 2019 to March 2020, who had undergone continuous erector spinae plane block as part of their analgesic regimen.
Results: A total of 6 patients, 4 females and 2 males with an average age of 75 years were identified. A reduction in pain intensity from acute to mild or absent was observed in every case, up to 24 hours after the initial injection. 66 % experienced a relapse of severe pain after 24 hours and 2 patients the catheter functionality failed after 24 hours. One patient underwent dermatome pinprick assessment.
Conclusions: The continuous erector spinae plane block with a single injection provided analgesic efficacy similar to other single injection peripheral blocks, although continuous analgesia for more than 24 hours was not achieved. Some variations in the block technique described may improve the analgesic effectiveness in patients with hip fracture pain.
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Booker SQ, Herr KA, Horgas AL. A Paradigm Shift for Movement-based Pain Assessment in Older Adults: Practice, Policy and Regulatory Drivers. Pain Manag Nurs 2021; 22:21-27. [PMID: 32948452 PMCID: PMC7886935 DOI: 10.1016/j.pmn.2020.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest. OBJECTIVE The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessment in older adults, as well as the practice, policy, and regulatory drivers that support this practice change.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, University of Florida, Gainesville, Florida.
| | - Keela A Herr
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Ann L Horgas
- College of Nursing, University of Florida, Gainesville, Florida
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Komann M, Baumbach P, Stamer UM, Weinmann C, Arnold C, Pogatzki-Zahn E, Meißner W. Desire to Receive More Pain Treatment - A Relevant Patient-Reported Outcome Measure to Assess Quality of Post-Operative Pain Management? Results From 79,996 Patients Enrolled in the Pain Registry QUIPS from 2016 to 2019. THE JOURNAL OF PAIN 2021; 22:730-738. [PMID: 33482323 DOI: 10.1016/j.jpain.2021.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/16/2020] [Accepted: 01/03/2021] [Indexed: 12/21/2022]
Abstract
Acute postoperative pain is frequently evaluated by pain intensity scores. However, interpretation of the results is difficult and thresholds requiring treatment are not well defined. Additional patient-reported outcome measures (PROMs) might be helpful to better understand individual pain experience and quality of pain management after surgery. We used data from the QUIPS pain registry for a cross-sectional study in order to investigate associations between the desire to receive more pain treatment (D2RMPT) with pain intensity ratings and other PROMs. Responses from 79,996 patients were analyzed, of whom 10.7% reported D2RMPT. A generalized estimating equation Poisson model showed that women had a lower risk ratio (RR) to answer this question with "yes" (RR: .92, P < .001). Factors that increased the risk most were "maximal pain intensity ≥ 6/10 on a numerical rating scale" (RR: 2.48, P < .001) and "any pain interference" (RR: 2.48, P < .001). The largest reduction in risk was observed if patients were "allowed to participate in pain treatment decisions" (RR: .41, P < .001) and if they felt that they "received sufficient treatment information" (RR: .58, P < .001). Our results indicate that the (easily assessed) question D2RMPT gives additional information to other PROMs like pain intensity. The small proportion of patients with D2RMPT (even for high pain scores) opens the discussion about clinicians' understanding of over- und under-treatment and questions the exclusive use of pain intensity as quality indicator. Future studies need to investigate whether asking about D2RMPT in clinical routine can improve postoperative pain outcome. PERSPECTIVE: This article presents characteristics of the patient-reported outcome measure "Desire to receive more pain treatment." This measure could be used to apply pain treatment in a more individualized way and lead to improved treatment strategies and quality.
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Affiliation(s)
- Marcus Komann
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
| | - Philipp Baumbach
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Ulrike M Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Claudia Weinmann
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Christin Arnold
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
| | - Winfried Meißner
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Gong J, Merry AF, Beyene KA, Campbell D, Frampton C, Jones P, McCall J, Moore M, Chan AHY. Persistent opioid use and opioid-related harm after hospital admissions for surgery and trauma in New Zealand: a population-based cohort study. BMJ Open 2021; 11:e044493. [PMID: 33468530 PMCID: PMC7817825 DOI: 10.1136/bmjopen-2020-044493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Opioid use has increased globally for the management of chronic non-cancer-related pain. There are concerns regarding the misuse of opioids leading to persistent opioid use and subsequent hospitalisation and deaths in developed countries. Hospital admissions related to surgery or trauma have been identified as contributing to the increasing opioid use internationally. There are minimal data on persistent opioid use and opioid-related harm in New Zealand (NZ), and how hospital admission for surgery or trauma contributes to this. We aim to describe rates and identify predictors of persistent opioid use among opioid-naïve individuals following hospital discharge for surgery or trauma. METHODS AND ANALYSIS This is a population-based, retrospective cohort study using linked data from national health administrative databases for opioid-naïve patients who have had surgery or trauma in NZ between January 2006 and December 2019. Linked data will be used to identify variables of interest including all types of hospital surgeries in NZ, all trauma hospital admissions, opioid dispensing, comorbidities and sociodemographic variables. The primary outcome of this study will be the prevalence of persistent opioid use. Secondary outcomes will include mortality, opioid-related harms and hospitalisation. We will compare the secondary outcomes between persistent and non-persistent opioid user groups. To compute rates, we will divide the total number of outcome events by total follow-up time. Multivariable logistic regression will be used to identify predictors of persistent opioid use. Multivariable Cox regression models will be used to estimate the risk of opioid-related harms and hospitalisation as well as all-cause mortality among the study cohort in a year following hospital discharge for surgery or trauma. ETHICS AND DISSEMINATION This study has been approved by the Auckland Health Research Ethics Committee (AHREC- AH1159). Results will be reported in accordance with the Reporting of studies Conducted using Observational Routinely collected health data statement (RECORD).
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Affiliation(s)
- Jiayi Gong
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Pharmacy Department, Auckland District Health Board, Auckland, New Zealand
| | - Alan Forbes Merry
- Department of Anaesthesiology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Department of Anaesthesia and Perioperative Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Kebede A Beyene
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Doug Campbell
- Department of Anaesthesiology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Department of Anaesthesia and Perioperative Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Peter Jones
- Department of Surgery, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - John McCall
- Department of Surgery, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Matthew Moore
- Department of Anaesthesiology, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Pharmacy Department, Auckland District Health Board, Auckland, New Zealand
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Liu Y, Hu Q, Yang J. Oliceridine for the Management of Acute Postoperative Pain. Ann Pharmacother 2021; 55:1283-1289. [PMID: 33423508 DOI: 10.1177/1060028020987679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To review the pharmacological characteristics, clinical evidence, and place in the management of acute postoperative pain severe enough to require an intravenous opioid. DATA SOURCES A comprehensive literature search was conducted in PubMed (January 2000 to December 1, 2020). Key search terms included oliceridine or acute postoperative pain. Other sources were derived from product labeling and ClinicalTrials.gov. STUDY SELECTION AND DATA EXTRACTION All English-language articles identified from the data sources were reviewed and evaluated. Phase I, II, and III clinical trials were included. DATA SYNTHESIS Oliceridine is a novel selective µ-receptor G-protein pathway modulator. It has the property of activating G-protein signaling while causing low β-arrestin recruitment to the µ-receptor. Intravenous oliceridine showed statistically superior analgesia than placebo in patients with moderate or severe pain after surgery, with a favorable safety and tolerability profile regarding respiratory and gastrointestinal adverse effects, compared with morphine. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The analgesic capacity of oliceridine is at least comparable to that of morphine at clinically relevant dosages, with a rapid onset of action. Also, it may be associated with a lower incidence of adverse events at dosing regimens associated with comparable analgesia. These data suggest that oliceridine may provide an important new treatment option for the management of moderate to severe postoperative pain where an intravenous opioid is warranted. CONCLUSION Oliceridine has obvious analgesic effects in patients with moderate or severe pain after surgery; additionally, it has a favorable safety and tolerability profile.
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Affiliation(s)
- Yang Liu
- Linyi Central Hospital, Shandong, China
| | - Qiang Hu
- Linyi Central Hospital, Shandong, China
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Durnin S, Barrett MJ, Lyttle MD, Hartshorn S. Structures of paediatric pain management: a PERUKI service evaluation study. BMJ Paediatr Open 2021; 5:e001159. [PMID: 34395928 PMCID: PMC8314722 DOI: 10.1136/bmjpo-2021-001159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/01/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pain is very common in childhood emergency department (ED) attendances, but is under-recognised and undertreated. Sequential national paediatric analgesia audits demonstrate suboptimal outcomes in several domains. The Donabedian framework examines the structures, processes and outcomes to evaluate quality of care. To date there has been no network-level exploration of structures supporting analgesic practices or attempts to address failure to attain national standards. OBJECTIVE To benchmark current variation in assessment and management of childhood pain at network level. METHODS Online survey distributed between December 2016 and January 2017 exploring health system structures including pain score tools, pain assessment/protocols, training, practice guidelines and analgesic agent usage. We explored structures, processes and outcomes to identify interventions, and their potential effectiveness and feasibility. RESULTS In total 95% (38/40 sites) responded, including 25 tertiary (66%) and 13 secondary hospitals (34%), with a total annual paediatric ED census of 1 225 000 (range 11 500-65 000). Availability of analgesics varied included topical wound anaesthesia in 29/38 sites (76%), oral diclofenac sodium in 22/38 sites (58%) and tramadol in 16/38 sites (42%). Pain assessment was mandatory in initial assessment in 34/38 sites (89%), and 18/38 sites had a policy on frequency of pain assessment (47%). Local guidance aligned with national guidance in 21/38 sites (55%). There was no staff training at induction/orientation in 14/38 sites (37%) and no mandatory competencies in pain management in 23/38 sites (61%). Play specialist services were available in 21/38 sites (55%). CONCLUSION Despite national guidance and recommendations from multiple audits, there are substantial variations in structures relating to pain assessment and management across sites. The lack of uniformity is a likely root cause for the persistent suboptimal practices identified by serial national audits. A whole system and person-centred approach to improving pain outcomes by utilising effective interventions seeks to improve paediatric pain outcomes.
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Affiliation(s)
- Sheena Durnin
- Paediatric Emergency Medicine, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Paediatric Emergency Medicine, Children’s Health Ireland at Tallaght, Dublin, Ireland
- Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland
| | - Michael J Barrett
- Paediatric Emergency Medicine, Children’s Health Ireland at Crumlin, Dublin, Ireland
- Women’s and Children’s Health, University College Dublin, Dublin, Ireland
| | - Mark D Lyttle
- Paediatric Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Stuart Hartshorn
- Paediatric Emergency Medicine, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Combination Effect of High-Dose Preoperative and Periarticular Steroid Injection in Total Knee Arthroplasty. A Randomized Controlled Study. J Arthroplasty 2021; 36:130-134.e2. [PMID: 32773268 DOI: 10.1016/j.arth.2020.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postoperative pain remains a major barrier to a patient's recovery after total knee arthroplasty (TKA). Periarticular corticosteroids in local infiltration analgesics (LIA) and high-dose intravenous corticosteroids have individually shown to improve pain control after TKA. However, potential interactions between them have not been investigated. This study aims to evaluate any combination effect of both routes of corticosteroids in TKA. METHODS This is a double-blinded, paired, randomized controlled trial involving 1-stage bilateral TKAs. All received 16 mg of dexamethasone intravenously. One knee was randomized to receive LIA with 40 mg of triamcinolone, while the other knee receives LIA without corticosteroids. For each patient, one knee was affected by intravenous steroids only, while the other was under the combined effect of intravenous and periarticular steroids (IVPAS). Knee pain, Southampton wound scores, and functional knee scores (Knee Society Knee Score and Oxford Knee Scores) were compared between knees of the same patient. RESULTS Forty-six patients (92 TKAs) were included. IVPAS knees showed significantly lower visual analog scale scores from day 1 to 6 weeks (P < .05) and a larger range of movement from day 2 to 4 (P < .05). IVPAS knees achieved active straight leg raise earlier than intravenous steroids (1.6 vs 2.3 days, P < .05). No differences in Southampton wound scores and functional knee scores for up to 1 year. CONCLUSION Combining intravenous and periarticular corticosteroids improved pain control and recovery after TKA with no increase in wound complications up to 1 year.
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Ferri CM, Natoli S, Sanz-Ayan P, Magni A, Guerrero C, Lara-Solares A, Liedgens H, Thömmes G, Karra R. Quality of life and functional outcomes with tapentadol prolonged release in chronic musculoskeletal pain: post hoc analysis. Pain Manag 2020; 11:173-187. [PMID: 33241725 DOI: 10.2217/pmt-2020-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aims: To investigate quality of life (QOL) and functionality changes in chronic pain during tapentadol prolonged release (PR) treatment. Patients & methods: Post hoc analysis of data from three Phase III trials in patients with osteoarthritis knee pain or low back pain. QOL and functionality changes were assessed by SF-36 scores. Results: All SF-36 subdomain scores improved progressively to week 3 of tapentadol titration and were sustained during 12-week maintenance treatment. Improvements in SF-36 scores were similar between tapentadol dose groups (e.g., 200 to <300 mg vs ≥500 mg), with no greater effect from higher doses. QOL and functionality improvements were consistently greater with tapentadol PR than oxycodone controlled release. Conclusion: Tapentadol PR provides consistent, clinically relevant improvements in QOL and functionality in chronic pain.
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Affiliation(s)
| | - Silvia Natoli
- University of Rome Tor Vergata, Department of Clinical Science & Translational Medicine & Unit of Pain Therapy, Polyclinic of Tor Vergata, Rome, 00133, Italy
| | - Paz Sanz-Ayan
- Hospital Universitario 12 de Octubre; Department of Rehabilitation, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
| | - Alberto Magni
- Italian College of General Practitioners & Primary Care, Florence, 50141, Italy
| | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá 110121, Universidad de los Andes, Colombia
| | - Argelia Lara-Solares
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14080, Mexico
| | | | - Guido Thömmes
- R&D - Development - Data Sciences, Grünenthal GmbH, Aachen, 52099, Germany
| | - Ravi Karra
- Global Medical Affairs, Grünenthal GmbH, Aachen, 52099, Germany
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Grundzüge des perioperativen Schmerzmanagements bei Säuglingen, Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Fang L, Chen L, Sun H, Xu Y, Jin J. The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center, Controlled before-after Study in China. Pain Manag Nurs 2020; 22:198-204. [PMID: 33039300 DOI: 10.1016/j.pmn.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/08/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown. AIMS The current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients. DESIGN A single-center, propensity score-matched, controlled before-after study. METHODS The patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses' pain knowledge and attitude between group A and group B. RESULTS A total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X2 = 38.926, p < .05; vomit: X2 = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05). CONCLUSION Our study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.
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Affiliation(s)
- Liangyu Fang
- Department of Anesthesiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Laijuan Chen
- Department of Anesthesiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hongling Sun
- Department of Specialist Nursing, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yinchuan Xu
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jingfeng Jin
- Department of Nursing, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Fu J, Zhang G, Qiu Y. Erector spinae plane block for postoperative pain and recovery in hepatectomy: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e22251. [PMID: 33031265 PMCID: PMC10545310 DOI: 10.1097/md.0000000000022251] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/24/2019] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The randomized controlled study aimed to examine the efficacy of preoperative ultrasound-guided erector spinae plane (ESP) block combined with ropivacaine in patients undergoing hepatectomy. METHODS A total of 60 patients were randomized to ESP block group receiving ropivacaine (Group A) and control group (Group B), n = 30 per group. Visual analog scale (VAS) was recorded in both the groups during rest and movement at the various time intervals. Both the groups were also compared for time to initial anal exhaust, analgesic usage, early postoperative complications and side-effects, walk distance after the operation, time to out-of-bed activity, and duration of hospital stay. RESULTS No significant differences were observed in the demographic characteristics. For group A, when compared to group B, VAS scores during rest and movement within post-operative 24 hours were decreased, the time of first anus exhaust and ambulation were earlier, analgesic consumption and the incidence of postoperative nausea, vomiting and headache was reduced, the duration of hospital stay were shorter with longer walk distance. CONCLUSION ESP block combined with ropivacaine treatment effectively reduced early postoperative pain and improved recovery after hepatectomy.
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Liu X, Li L, Wang L, Herr K, Chen Q. Implementation and evaluation of a pain management core competency education program for surgical nurses. Int J Nurs Sci 2020; 8:51-57. [PMID: 33575445 PMCID: PMC7859541 DOI: 10.1016/j.ijnss.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/30/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the effect of a pain management core competency education program on surgical nurses’ pain knowledge and pain management nursing practice behaviors. Methods An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain, pain assessment, pharmacological and non-pharmacological management, and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team. Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used. The Clinical Pain Knowledge Test (CPKT) was completed by 135 and 107 nurses from 17 surgical wards pre and post-program, respectively. Two hundred and three patients’ medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention, respectively. Documentation of patients’ postoperative pain management nursing practice behaviors and pain intensity scores were collected. Results After the intervention, the CPKT scores of nurses significantly increased from 45.6% ± 12.3% to 54.2% ± 10.2% (t = 5.786, P < 0.001). Nurses’ postoperative pain management nursing practice improved, with proportion of pain assessment documentation increased from 59.6% (121/203) to 74.9% (152/203) (χ2 = 10.746, P = 0.001), those using pain intensity assessment tools increased from 81.8% (99/121) to 95.4% (145/152) (χ2 = 13.079, P < 0.001), and intramuscular injection of nonopioids decreased from 12.6% (13/103) to 2.7% (3/111) (χ2 = 7.598, P = 0.006). Patients’ average worst pain score on the operation day significantly decreased (Z = −2.486, P = 0.013), and scores from the first to the third postoperative day also decreased (Z = −2.172, P = 0.030). Conclusions Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management, improve selected pain management practices, and decrease patients’ postoperative pain intensity.
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Affiliation(s)
- Xuelian Liu
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Li Li
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lingxiao Wang
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, IA, United States
| | - Qiuchan Chen
- Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Preoperative Chronic and Acute Pain Affects Postoperative Cognitive Function Mediated by Neurotransmitters. J Mol Neurosci 2020; 71:515-526. [PMID: 32901371 DOI: 10.1007/s12031-020-01673-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/20/2020] [Indexed: 02/08/2023]
Abstract
The effective prevention of postoperative cognitive dysfunction (POCD) needs to be explored, and the effect of preoperative pain on POCD remains unclear. We established a chronic pain model induced by chronic constriction injury (CCI) and models of acute pain and anxiety without pain in mice that were subsequently subjected to partial hepatectomy surgery. Morris water maze (MWM) tests were performed to evaluate the learning and memory abilities of the mice. ELISA was used to measure IL-1β, IL-6, and TNF-α in serum, and HPLC-MS was used to detect neurotransmitters in the prefrontal cortices and hippocampi of the mice. The results indicated that chronic pain induced by CCI might have significantly impaired the learning and memory abilities of mice, while acute pain and anxiety without pain only affected the memory abilities of mice. Perioperative acute pain increased the level of IL-1β in serum, and CCI might have increased the level of IL-6. CCI and acute pain increased dopamine (DA) levels in the cortex, similar to anxiety. Like anxiety, CCI increased 5-hydroxytryptamine (5-HT) levels in the prefrontal cortex and hippocampus. Acute pain led to a decrease in the acetylcholine (ACH) level in the hippocampus. Our results suggest that acute pain and CCI-induced chronic pain might aggravate postoperative cognitive dysfunction via neurotransmitters and by changing the levels of inflammatory factors such as IL-1β and IL-6.
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Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital. ScientificWorldJournal 2020; 2020:6829153. [PMID: 32848513 PMCID: PMC7439173 DOI: 10.1155/2020/6829153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.
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Abstract
Chronic pain management during the coronavirus disease 2019 (COVID-19) pandemic is a challenging process, especially with growing evidence that COVID-19 infection is associated with myalgias, referred pain, and widespread hyperalgesia. In light of the limited data available for COVID-19-related impact on chronic pain patients, this review explores the changes in the healthcare delivery system due to social distancing and safety precautions to provide the appropriate management of chronic pain patients during the COVID-19 pandemic. Understanding both the general problems facing chronic pain patients as well as specific problems in the COVID-19 era including deconditioning, increased mental health concerns, financial burdens, and potential for medication-induced immune-suppression is vital in the appropriate management of patients. Telemedicine, the practice of caring for patients remotely when the provider and patient are not physically present with each other, is becoming increasingly used and recognized as a valuable tool to both health care providers and patients. This paper concentrates on the proper utilization of the available resources to help patients with the most severe conditions as well as the most vulnerable group. COVID-19 may be associated with a profound effect on both the health care system and patients with chronic pain. As a result, delaying, or stopping, treatment for chronic pain patients will have negative consequences, and strong pain evaluations must be administered to triage patients appropriately. Recent recommendations for the safe use of non-opioid analgesics, opioid analgesics, and interventional pain management procedures are vital to know and understand specifically during the pandemic era. Further researches are needed to identify the advance planning and rapid responses to reduce the impact of the pandemic.
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Schug S, Pogatzki-Zahn E, Phillips LD, Essex MN, Xia F, Reader AJ, Pawinski R. Multi-Criteria Decision Analysis to Develop an Efficacy-Safety Profile of Parenteral Analgesics Used in the Treatment of Postoperative Pain. J Pain Res 2020; 13:1969-1977. [PMID: 32801852 PMCID: PMC7415456 DOI: 10.2147/jpr.s255921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Identifying the optimal treatment in an acute postoperative setting remains a challenge. Multiple analgesic options are available, but comparing outcomes is limited by a lack of head-to-head trials. In addition, decisions based on efficacy only do not take drug safety into account. In such cases, multi-criteria decision analysis (MCDA) can be utilized to quantify and compare the efficacy and safety data of various drugs. Methodology The efficacy-safety profiles of eight parenteral, postoperative analgesics (acetaminophen, diclofenac, ketorolac, metamizole, morphine, nefopam, parecoxib, tramadol) widely used in Europe were evaluated using an MCDA model that included 17 criteria: three for efficacy and 14 for safety. Each drug was scored on each criterion on a scale from 0 (worst) to 100 (best), according to published data and the judgment of an expert panel. A weighting process was then applied to standardize the impact of each criterion and adjust drugs' preference scores accordingly, normalizing them on the 0-100 scale. Sensitivity analyses were also performed, including a model in which analgesic profiles were compared when opioid sparing effect was set at a zero value for all drugs. Results In the primary model, efficacy and safety had relative weightings of 64% and 36%, respectively. Efficacy and safety criteria with the highest values were pain relief (relative weight, 29%) and gastrointestinal effects (12%). Parecoxib received the highest overall score (93), followed by diclofenac (80), and ketorolac (75). Morphine scored the lowest (57), due to the lack of an opioid sparing effect. When opioid sparing was given a zero rating, parecoxib remained the highest scoring analgesic (93), followed by diclofenac (80), metamizole (76), and morphine (76). Parecoxib remained the most preferred analgesic in several other sensitivity analyses. Conclusion This MCDA-based assessment suggests that parecoxib has the most favorable efficacy-safety profile among the assessed postoperative analgesics.
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Affiliation(s)
- Stephan Schug
- Discipline of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Muenster, Muenster, Germany
| | - Lawrence D Phillips
- Department of Management, London School of Economics and Political Science, London, UK
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Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Rep 2020; 5:e831. [PMID: 32766467 PMCID: PMC7390596 DOI: 10.1097/pr9.0000000000000831] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 01/01/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Eight risk factors were identified in a large international database. Patients with 3 or more risk factors are at higher risk for poor pain outcome. Background: The aim of this study was to determine simple risk factors for severe pain intensity (≥7 points on a numeric rating scale [NRS]), to analyse their relation to other patient-reported outcome measures and to develop a simple prediction model. Methods: We used data from 50,005 patients from the PAIN-OUT project. Within a first data set (n = 33,667), relevant risk factors were identified by logistic binary regression analysis, assessed for additional patient-reported outcome measures beyond pain intensity and summed up for developing a simple risk score. Finally, sum of factors was plotted against postoperative pain outcomes within a validation data set (n = 16,338). Results: Odds ratios (OR) for the following risk factors were identified: younger age (<54 years, OR: 1.277), preoperative chronic pain at the site of surgery (OR: 1.195), female sex (OR: 1.433), duration of surgery (>90 minutes, OR: 1.308), preoperative opioid intake (OR: 1.250), feeling anxious (OR: 1.239) and feeling helpless due to pain (OR: 1.198), and the country of the recruiting centre (OR: 1.919). Patients with ≥3 risk factors had more severe pain intensity scores, spent a longer time in severe pain, and wished to have received more pain treatment (P < 0.001). A simple risk score was created with 4 risk factors showing a moderate prediction level. Conclusions: Patients with ≥3 risk factors are at higher risk for poor postoperative acute pain outcome after surgery. Future studies using this score might show that preventive strategies might decrease pain intensity, pain-related postoperative dysfunction, and the development of chronic pain.
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Regional anesthesia for vascular surgery: does the anesthetic choice influence outcome? Curr Opin Anaesthesiol 2020; 32:690-696. [PMID: 31415047 DOI: 10.1097/aco.0000000000000781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Outcomes following surgery are of major importance to clinicians, institutions and most importantly patients. This review examines whether regional anesthesia and analgesia influence outcome after vascular surgery. RECENT FINDINGS Large database analyses of contemporary practice suggest that utilizing regional anesthesia for both open and endovascular aortic aneurysm repair, lower limb revascularization and carotid endarterectomy reduces morbidity, length of stay and possibly even mortality. Results from such analyses are limited by an inherent risk of bias but are nevertheless important given the number of patients required in randomized trials to detect differences in rare outcomes. There is minimal evidence that regional anesthesia influences longer term outcomes except for arteriovenous fistula surgery where brachial plexus blocks appear to improve 3-month fistula patency. SUMMARY Patients undergoing vascular surgery often have multiple comorbidities and it is important to be able to outline both benefits and risks of regional anesthesia techniques. Regional anesthesia in vascular surgery allows avoidance of general anesthesia and does provide short-term benefits beyond superior analgesia. Evidence of long-term benefits is lacking in most procedures. Further work is required on newer patient centered outcomes.
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American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions. Pain Manag Nurs 2020; 21:7-25. [DOI: 10.1016/j.pmn.2019.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 01/12/2023]
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Wang XQ, Duan PB, Zheng M, Xu Q, Yang LH, Wang AQ. Perioperative auricular acupuncture technique via intradermal needling buried for postoperative movement-evoked pain after open radical gastrectomy: Study protocol for a pilot randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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The Promotion of Policy Changes Restricting Access to Codeine Medicines on Twitter: What do National Pain Organizations Say? THE JOURNAL OF PAIN 2019; 21:881-891. [PMID: 31857206 DOI: 10.1016/j.jpain.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/17/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Codeine is one of the most common opioid medicines for treating pain. Australia introduced policy changes in February 2018 to up-schedule codeine to prescription-only medicine due to concerns of adverse effects, opioid dependency, and overdose-related mortality. This study investigated the frequency and content of messages promoted on Twitter by 4 Australian peak pain organizations, pre- and postpolicy implementation. A time series analysis examined frequency of Twitter posts over a 48-week period. Text analysis via Leximancer examined message content. Results showed that promotion and education of the pending policy change dominated the Twitter feed prior to up-scheduling. However, immediately following policy change, there was a shift in content towards promoting conferences and research, and a significant decrease in the frequency of codeine-related posts, compared to opioid-related non-codeine posts. The findings suggest that pain organizations can provide timely and educational policy dissemination in the online environment. They have implications for individuals with chronic pain who use the Internet for health information and the degree to which they can trust these sources, as well as health professionals. Further research is required to determine if public health campaigns can be targeted to prevent opioid-related harm and improve pain care via this increasingly used medium. PERSPECTIVE: This study presents a first look at what information is being communicated by influential pain organizations that have an online Twitter presence and how messages were delivered during a major policy change restricting access to codeine medicines. Insights could drive targeted future online health campaigns for improved pain management.
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Patel P, Ivanov D, Bhatt S, Mastorakos G, Birckhead B, Khera N, Vittone J. Low-Cost Virtual Reality Headsets Reduce Perceived Pain in Healthy Adults: A Multicenter Randomized Crossover Trial. Games Health J 2019; 9:129-136. [PMID: 31804853 DOI: 10.1089/g4h.2019.0052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives: Recent studies have established the usage of virtual reality (VR) to help alleviate acute and chronic pain. VR technology can be cost prohibitive and cheaper alternatives are desired. In this study, a Google Cardboard headset ($15) combined with a smartphone was used as a low-cost VR device to assess efficacy in altering the perception of pain. Materials and Methods: The cold pressor test, a minimal-risk method, was used to simulate pain. Participants immersed their hands into ice water, with and without VR, in a crossover manner, and their pain perception data were recorded. Results: Forty-eight healthy volunteer participants completed the study between 2017 and 2018. Participants were randomized to right hand control, left control, right experimental, and left experimental groups, respectively, before the crossover. Data collected included pain threshold (time at which participants first reported pain), pain tolerance (time at which participants removed their hand), and pain intensity (highest reported pain level on a [1-10] scale). Approximately two-thirds of participants had improvements in pain threshold and pain tolerance with a mean improvement of +13.0 seconds (P = 0.0045) for pain threshold and +29.8 seconds (P = 0.0003) for pain tolerance. Pain intensity had a reduction of 0.43 points (P = 0.0371). Conclusion: Our results demonstrate that inexpensive VR devices, such as the Google Cardboard headset used in this study, may be a safe, portable, and cost-effective way to alter the perception and improve tolerance of pain.
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Affiliation(s)
- Payal Patel
- Mayo Clinic School of Medicine, Rochester, Minnesota
| | - David Ivanov
- Mayo Clinic School of Medicine, Rochester, Minnesota
| | | | | | - Brandon Birckhead
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nandita Khera
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | - Janet Vittone
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Cornelis FH, Monard E, Moulin MA, Vignaud E, Laveissiere F, Ben Ammar M, Nouri-Neuville M, Barral M, Lombart B. Sedation and analgesia in interventional radiology: Where do we stand, where are we heading and why does it matter? Diagn Interv Imaging 2019; 100:753-762. [PMID: 31706790 DOI: 10.1016/j.diii.2019.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/13/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Abstract
The aims of this review were to describe the rationale and the techniques of sedation in interventional radiology, and to compile the safety and efficacy results available so far in the literature. A systematic MEDLINE/PubMed literature search was performed. Preliminary results from several studies demonstrated the feasibility, the efficacy and the safety of using sedative techniques in interventional radiology. Beyond pharmacological sedation and clinical hypnosis, digital sedation could reduce the anxiety and pain associated with interventional radiology procedures.
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Affiliation(s)
- F H Cornelis
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France.
| | - E Monard
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - M-A Moulin
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - E Vignaud
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - F Laveissiere
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - M Ben Ammar
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - M Nouri-Neuville
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - M Barral
- Department of Radiology, Tenon Hospital, Sorbonne University, AP-HP, 75020 Paris, France
| | - B Lombart
- Saint Antoine Hospital, Sorbonne université, AP-HP, 75011 Paris, France
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Velazquez Cardona C, Rajah C, Mzoneli YN, Friedrichsdorf SJ, Campbell F, Cairns C, Rodseth RN. An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital. Pain Rep 2019; 4:e789. [PMID: 31984294 PMCID: PMC6903419 DOI: 10.1097/pr9.0000000000000789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/25/2019] [Accepted: 08/21/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries. OBJECTIVES This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa. METHOD A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa. RESULTS Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores. CONCLUSION The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.
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Affiliation(s)
- Caridad Velazquez Cardona
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Grey's Hospital Pain Services Commitee, Pietermaritzburg, South Africa
| | - Chantal Rajah
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Youley Nosisi Mzoneli
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stefan Joerg Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Fiona Campbell
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Carel Cairns
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Grey's Hospital Pain Services Commitee, Pietermaritzburg, South Africa
| | - Reitze Nils Rodseth
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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Meissner W, Zaslansky R. A survey of postoperative pain treatments and unmet needs. Best Pract Res Clin Anaesthesiol 2019; 33:269-286. [PMID: 31785713 DOI: 10.1016/j.bpa.2019.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
More than 300 million patients undergo surgery worldwide each year. Pain associated with these procedures is associated with short- and long-term negative sequelae for patients, healthcare providers, and healthcare systems. The following chapter is a review of the reality of postoperative pain management in everyday clinical routine based on survey- and registry-derived data with a focus on care in adults. Between 30% and up to 80% of patients report moderate to severe pain in the days after surgery. Structures, processes, and outcomes vary widely between hospitals and indicate gaps between evidence-based findings and practice. Pain assessment is not effectively implemented in many hospitals and should consider cultural differences. Few data exist on the situation of pain management in low- and middle-income countries, indicating lack of resources and available medication in many of these areas. Certain types of surgery as well as demographic and clinical factors are associated with increased risk of severe postoperative pain.
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Affiliation(s)
- Winfried Meissner
- Dept of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07740 Jena, Germany.
| | - Ruth Zaslansky
- Dept of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07740 Jena, Germany
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Idon PI, Sotunde OA, Ogundare TO. Beyond the Relief of Pain: Dentin Hypersensitivity and Oral Health-Related Quality of Life. Front Dent 2019; 16:325-334. [PMID: 32123872 PMCID: PMC7040559 DOI: 10.18502/fid.v16i5.2272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
Pain is a constant symptom of dentin hypersensitivity (DH), which is a common condition that affects daily life and negatively affects the quality of life (QoL). Diagnosis and outcome measurements following the treatment of the disease require accurate pain assessment. The definition of pain underlies the complexity of its measurement as different factors modulate daily experience. The reproducibility of the prescribed stimuli for inducing DH pain clinically is difficult to achieve. This pain mevaasurement is made with unidimensional scales that are inadequate to capture the other dimensions of pain. The only specific QoL tool available for DH still requires testing in other populations and cultures. This article reviews the appropriateness of the current methods of DH pain assessment and the tools that consider the other pain dimensions. It also looks at its impact on the oral health-related quality of life (OHRQoL) of people with DH. The findings will create interest and facilitate research in this field of DH pain measurement and management.
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Affiliation(s)
- Paul Ikhodaro Idon
- Department of Dental Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Olawale Akeem Sotunde
- Department of Restorative Dentistry, Faculty of Dentistry, Bayero University, Kano, Nigeria
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Colquhoun L, Shepherd V, Neil M. Pain management in new amputees: a nursing perspective. ACTA ACUST UNITED AC 2019; 28:638-646. [PMID: 31116597 DOI: 10.12968/bjon.2019.28.10.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Phantom limb pain (PLP) is a widespread and challenging neuropathic pain problem, occurring after both surgical and traumatic amputation of a limb. It may occur immediately after surgery or some months later, however, most cases it presents within the first 7 postoperative days. Patients report a range of pain characteristics in the absent limb, including burning, cramping, tingling and electric shock sensation. The incidence of PLP has been reported to be between 50% and 85% following amputation. Its management is notoriously difficult, with no clear consensus on optimal treatment. It is often resistant to classic balanced analgesia and typical neuropathic pain medications. Taking into account these issues, the authors aimed to improve the management of patients undergoing amputation at their institution, by ensuring accurate and holistic assessment, the selection of suitable interventions through critical analysis and synthesis of available evidence, and the appropriate evaluation and adaptation of treatment plans, to ensure patients achieved their individualised goals.
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Affiliation(s)
- Liz Colquhoun
- Senior Pain Nurse Specialist, NHS Tayside Pain Service, Ninewells Hospital, Dundee
| | - Val Shepherd
- Senior Pain Nurse Specialist, NHS Tayside Pain Service, NHS Tayside, Dundee
| | - Michael Neil
- Consultant in Anaesthetics and Pain Medicine, NHS Tayside Pain Service, NHS Tayside, Dundee
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82
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Odejobi Y, Maneewat K, Chittithavorn V. Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital. Int Nurs Rev 2019; 66:434-441. [DOI: 10.1111/inr.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Y.O. Odejobi
- Faculty of Nursing Prince of Songkla University Songkla Thailand
| | - K. Maneewat
- Faculty of Nursing Prince of Songkla University Songkla Thailand
| | - V. Chittithavorn
- Faculty of Medicine Prince of Songkla University Songkla Thailand
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83
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Hartshorn S, Barrett MJ, Lyttle MD, Yee SA, Irvine AT. Inhaled methoxyflurane (Penthrox®) versus placebo for injury-associated analgesia in children-the MAGPIE trial (MEOF-002): study protocol for a randomised controlled trial. Trials 2019; 20:393. [PMID: 31272493 PMCID: PMC6610896 DOI: 10.1186/s13063-019-3511-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/10/2019] [Indexed: 12/14/2022] Open
Abstract
Background Pain from injuries is one of the commonest symptoms in children attending emergency departments (EDs), and this is often inadequately treated in both the pre-hospital and ED settings, in part due to challenges of continual assessment and availability of easily administered analgesic options. Pain practices are therefore a key research priority, including within the field of paediatric emergency medicine. Methoxyflurane, delivered via a self-administered Penthrox® inhaler, belongs to the fluorinated hydrocarbon group of volatile anaesthetics and is unique among the group in having analgesic properties at low doses. Despite over 30 years of clinical acute analgesia use, and a large volume of evidence supporting its safety and efficacy, there is a paucity of randomised controlled trial data for Penthrox®. Methods This is an international multi-centre randomised, double-blind, placebo-controlled phase III trial assessing the efficacy and safety of methoxyflurane delivered via the Penthrox® inhaler for the management of moderate to severe acute traumatic pain in children and young people aged 6–17 years. Following written informed consent, eligible participants are randomised to self-administer either inhaled methoxyflurane (maximum dose of 2 × 3 ml) or normal saline placebo (maximum dose 2 × 5 ml). Patients, treating clinicians and research nurses are blinded to the treatment. The primary outcome is the change in pain intensity at 15 min after the commencement of treatment, as measured by the Visual Analogue Scale (VAS) or the Wong-Baker FACES® Pain Rating scale, with the latter converted to VAS values. Secondary outcome measures include the number and proportion of responders who achieve a 30% reduction in VAS score compared to baseline, rescue medication requested, time and number of inhalations to first pain relief, global medication performance assessment by the patient, clinician and research nurse, and evaluation of adverse events experienced during treatment and during the subsequent 14 ± 2 days. The primary analysis will be by intention to treat. The total sample size is 110 randomised and treated patients per treatment arm. Discussion The Methoxyflurane AnalGesia for Paediatric InjuriEs (MAGPIE) trial will provide efficacy and safety data for methoxyflurane administered via the Penthrox® inhaler, in children and adolescents who present to EDs with moderate to severe injury-related pain. Trial registration EudraCT, 2016–004290-41. Registered on 11 April 2017. ClinicalTrials.gov, NCT03215056. Registered on 12 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3511-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stuart Hartshorn
- Emergency Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Michael J Barrett
- Emergency Department, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,National Children's Research Centre, Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sue Anne Yee
- Medical Developments International Limited, Scoresby, VIC, Australia
| | - Alan T Irvine
- Medical Developments International Limited, Scoresby, VIC, Australia
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84
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Hargett JL, Criswell AC. Non-pharmacological interventions for acute pain management in patients with opioid abuse or opioid tolerance: a scoping review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1283-1289. [PMID: 30864979 DOI: 10.11124/jbisrir-2017-003878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map the evidence on non-pharmacological interventions for acute pain management in patients with opioid tolerance and opioid abuse. INTRODUCTION The mainstay of pain management for adults experiencing moderate to severe acute pain is opioid therapy. However, in light of the known risks of opioid use and the growing number of patients with opioid tolerance or opioid abuse, non-pharmacological interventions are of increasing interest to healthcare providers. Non-pharmacological techniques have shown potential in reducing postoperative pain, opioid consumption, stress and anxiety. INCLUSION CRITERIA Eligible studies will include participants in a hospital or healthcare facility who are experiencing acute pain and have a tolerance to or dependence on opioids. Studies that examine non-pharmacological interventions for treating acute pain in these patients will be considered. Non-pharmacological interventions may include, but are not limited to, acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, laser therapy, low-level light therapy, meditation, biofeedback, hypnosis and relaxation techniques. Only studies published in English will be included, and there will be no limit on dates of publication. METHODS PubMed, CINAHL, Scopus, Embase, Europe PubMed Central, PsycINFO, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov will be searched, as well as sources of unpublished studies. After screening the titles and abstracts of identified citations, two independent reviewers will retrieve potentially relevant full-text studies, assess methodological quality and extract data. Data will be presented in diagrammatic or tabular form, and a qualitative thematic analysis will be undertaken. A narrative summary will accompany the tabulated results.
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Affiliation(s)
- Jennifer L Hargett
- School of Nursing, University of Mississippi Medical Center, Jackson, USA
- Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Amanda C Criswell
- School of Nursing, University of Mississippi Medical Center, Jackson, USA
- Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
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85
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Stanley B, Jackson A, Norman A, Collins L, Bonomo A, Bonomo Y. Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice. ANZ J Surg 2019; 89:1302-1307. [DOI: 10.1111/ans.15305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Beata Stanley
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Aidan Jackson
- The University of Melbourne Melbourne Victoria Australia
| | - Amanda Norman
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Lisa Collins
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Anthony Bonomo
- Department of OrthopaedicsSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Yvonne Bonomo
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
- The University of Melbourne Melbourne Victoria Australia
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86
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Vink P, Torensma B, Lucas C, Hollmann MW, van Schaik IN, Vermeulen H. How incremental video training did not guarantee implementation due to fluctuating population prevalence. BMJ Open Qual 2019; 8:e000447. [PMID: 31206052 PMCID: PMC6542455 DOI: 10.1136/bmjoq-2018-000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/21/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022] Open
Abstract
Patients with stroke admitted at the neurology/neurosurgery ward of the Academic Medical Centre in Amsterdam, The Netherlands, may experience problems in communication, such as aphasia, severe confusion/delirium or severe language barriers. This may prevent self-reported pain assessment; therefore, pain behaviour observation scales are needed. In this project, we therefore aimed to implement the Rotterdam Elderly Pain Observation Scale (REPOS) by video training. We used a stepped-wedge cluster design with clusters of four to five nurses with intervals of 2 weeks, for a total study duration of 34 weeks. Primary endpoint was the proportion of shifts in which nurses used the REPOS when caring for an eligible patient. A questionnaire was send biweekly to assess self-perceived competence and attitude on pain measurement in patients able or unable to self-report pain intensity. No other strategies were used to promote the use of the REPOS. Though the proportion of shifts in which trained nurses cared for eligible patients increased from 0% at baseline to 83% at the end of the study, the proportion of cumulative shifts where the REPOS was used decreased from 14% to 6%, respectively. Process evaluation suggests that this decrease can (in part) be attributed to low and varying prevalence of eligible patients and opportunities for practice. In total, 24 (45.3%) nurses had used the REPOS at least once after 34 weeks, with a median of two times (1–33). Nurses perceived themselves 'competent' to 'very competent' in pain behaviour observation. There was no negative attitude towards pain measurement. This study shows that education alone may not be effective when implementing a pain behaviour observation scale for non-communicative patients with Acquired Brain Injury. Individual motivation of health professionals and individual patient factors may be of influence for the use of the REPOS.
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Affiliation(s)
- Peter Vink
- Neuro and Head/Neck, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands.,Omni Cura Nursing Teaching Research, Amsterdam, The Netherlands
| | - Bart Torensma
- Department of Anesthesiology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cees Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud UMC, Nijmegen, The Netherlands
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87
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Li Y, Chu L, Li X, Zhai W, Ma Y, He Y, Xu Y, Ding S, Gao H, Zhang J, Ye B, Wang J, Yao J, Wu C, Xiao L. Efficacy of different-frequency TEAS on acute pain after the total knee arthroplasty: a study protocol for a parallel group randomized trial. Trials 2019; 20:306. [PMID: 31142359 PMCID: PMC6542097 DOI: 10.1186/s13063-019-3379-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/22/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an optimal option for patients with middle-to-end-stage knee osteoarthritis. However, the management of postoperative acute pain remains inefficient. Transcutaneous electrical acupoint stimulation (TEAS) is a nonpharmacological method to manage postoperative acute pain. Different frequencies of TEAS have been tested using varying parameters, but the optimal analgesic frequency remains controversial. The aim of this study was to explore the optimal analgesic frequency of TEAS for treating acute pain after the primary unilateral TKA. METHODS/DESIGN This is a double-blind, randomized controlled trial. A total of 156 patients are randomly assigned to: G1, 5 Hz TEAS; G2, 100 Hz TEAS; G3, mixed TEAS (alternative use of daily 5 Hz and 100 Hz TEAS) and G4, placebo TEAS. In the G1, G2 and G3 groups, TEAS is conducted at acupoints SP9 and GB34 of the leg that was operated on (at a wave of continuous, balanced and asymmetrical biphasic square, with a pulse width of 200 μs, and a strong but comfortable current) for 30 min prior to a 30-min rehabilitation session per day for 2 weeks. In G4 group, TEAS is delivered at a strong but comfortable current for 30 s, then the current is gradually decreased to none over the next 15 s. The primary outcomes are measured before surgery, at baseline (POD 3, before TEAS intervention), week 1 and 2 after TEAS intervention with the Numeric Pain Rating Scale and The American Knee Society Score. The secondary outcomes include: (1) Active range of motion of the knee that was operated on; (2) Surface electromyography of both quadriceps; (3) Modified 30-s sit to stand test; (4) Additional usage of analgesia; and (5) SF-36. The additional outcomes include: (1) Patients' satisfaction rate; (2) Patient's expectation rate; and (3) Incidence of analgesia-related side effects. To test the blinding of participants and assessors, they are asked to guess whether the subjects received active or placebo TEAS within 5 min after the latest intervention. The safety and financial cost of TEAS are assessed. DISCUSSION Mixed TEAS has more favorable effect on acute pain control than the placebo or 5 Hz or 100 Hz TEAS. TRIAL REGISTRATION ChiCTR1800016347 . Date of registration was 26 May 2018. Retrospectively registered.
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Affiliation(s)
- Yulin Li
- Faculty of Rehabilitation Medicine, The Shanghai University of Traditional Chinese Medicine, Shanghai, 200000 China
| | - Lixi Chu
- Faculty of Rehabilitation Medicine, The Shanghai University of Traditional Chinese Medicine, Shanghai, 200000 China
| | - Xiangming Li
- Department of Orthopaedics, Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, The Shanghai University of Traditional Chinese Medicine, Shanghai, 200000 China
| | - Weitao Zhai
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Yinghui Ma
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Yong He
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Yuelin Xu
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Sheng Ding
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Huali Gao
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Jing Zhang
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Bowen Ye
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Jingchao Wang
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Jie Yao
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Chonggui Wu
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
- Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
| | - Lianbo Xiao
- Guanghua Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200000 China
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Raff M, Belbachir A, El-Tallawy S, Ho KY, Nagtalon E, Salti A, Seo JH, Tantri AR, Wang H, Wang T, Buemio KC, Gutierrez C, Hadjiat Y. Intravenous Oxycodone Versus Other Intravenous Strong Opioids for Acute Postoperative Pain Control: A Systematic Review of Randomized Controlled Trials. Pain Ther 2019; 8:19-39. [PMID: 31004317 PMCID: PMC6514019 DOI: 10.1007/s40122-019-0122-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Optimal pain management is crucial to the postoperative recovery process. We aimed to evaluate the efficacy and safety of intravenous oxycodone with intravenous fentanyl, morphine, sufentanil, pethidine, and hydromorphone for acute postoperative pain. Methods A systematic literature search of PubMed, Cochrane Library, and EMBASE databases was performed for randomized controlled trials published from 2008 through 2017 (inclusive) that evaluated the acute postoperative analgesic efficacy of intravenous oxycodone against fentanyl, morphine, sufentanil, pethidine, and hydromorphone in adult patients (age ≥ 18 years). Outcomes examined included analgesic consumption, pain intensity levels, side effects, and patient satisfaction. Results Eleven studies were included in the review; six compared oxycodone with fentanyl, two compared oxycodone with morphine, and three compared oxycodone with sufentanil. There were no eligible studies comparing oxycodone with pethidine or hydromorphone. Overall, analgesic consumption was lower with oxycodone than with fentanyl or sufentanil. Oxycodone exhibited better analgesic efficacy than fentanyl and sufentanil, and comparable analgesic efficacy to morphine. In terms of safety, there was a tendency towards more side effects with oxycodone than with fentanyl, but the incidence of side effects with oxycodone was comparable to morphine and sufentanil. Where patient satisfaction was evaluated, higher satisfaction levels were observed with oxycodone than with sufentanil and comparable satisfaction was noted when comparing oxycodone with fentanyl. Patient satisfaction was not evaluated in the studies comparing oxycodone with morphine. Conclusions Our findings suggest that intravenous oxycodone provides better analgesic efficacy than fentanyl and sufentanil, and comparable efficacy to morphine with less adverse events such as sedation. No studies comparing intravenous oxycodone with pethidine or hydromorphone were identified in this review. Better alignment of study methodologies for future research in this area is recommended to provide the best evidence base for a meta-analysis. Funding Mundipharma Singapore Holding Pte Ltd, Singapore. Electronic supplementary material The online version of this article (10.1007/s40122-019-0122-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Milton Raff
- Pain Clinic, Christiaan Barnard Memorial Hospital, Cape Town, South Africa.
| | - Anissa Belbachir
- Faculté de médecine, Université Paris-Descartes, Pôle d'anesthésie-réanimation, Hôpital Cochin, Paris, France
| | - Salah El-Tallawy
- Department of Anesthesia and Pain Management, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Kok Yuen Ho
- The Pain Clinic, Mount Alvernia Medical Centre, Singapore, Singapore
| | - Eric Nagtalon
- Department of Anesthesia, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Amar Salti
- Anesthesiology Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Aida Rosita Tantri
- Department of Anesthesiology and Intensive Care, Universitas Indonesia, Dr. Ciptomangunkusumo National General Hospital, Jakarta, Indonesia
| | - Hongwei Wang
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | | | | | - Yacine Hadjiat
- Mundipharma Singapore Holding Pte. Ltd., Singapore, Singapore
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Birch S. Treating the patient not the symptoms: Acupuncture to improve overall health - Evidence, acceptance and strategies. Integr Med Res 2019; 8:33-41. [PMID: 30949430 PMCID: PMC6428918 DOI: 10.1016/j.imr.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023] Open
Abstract
Documented mechanisms of acupuncture suggest the possibility of whole body effects in addition to local and regional effects. Traditional theories of acupuncture predict whole body effects. Does this permit the possibility of applying treatment to target overall health improvement of the patient rather than the symptom? After introducing the term 'health improvement' this paper explores situations where it might be advantageous to do this, giving examples of how health authorities in some countries have proposed broader treatment approaches that focus on health improvement. It also discusses cases where acupuncture has been recommended as a treatment method in a number of these proposals and gives some clinical examples of this kind of whole body 'health improvement' targeted treatment effects. Given that health authorities have already recognised this potential for the application of acupuncture the author then explores evidence of more whole-body 'health improvement' effects from systematic reviews and examples of health experts recommending acupuncture to take advantage of them. Research strategies and foci are then proposed and explored to develop this evidence. What are the best treatment approaches to create these effects? By what mechanisms can 'health improvement' be produced? How can one measure these effects? It is likely that treatments based on 'pattern identification' (PI) may provide the best strategies for producing 'health improvement', thus PI-based acupuncture treatments are likely to be the best strategy for clinical research investigating these effects.
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Affiliation(s)
- Stephen Birch
- Department of Health Sciences, Kristiania University College, Oslo, Norway
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90
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Abstract
OBJECTIVE Dexketoprofen trometamol is a modified non-selective COX inhibitor with a rapid onset of action that is available as both oral and parenteral formulations. The aim of this narrative review was to assess the efficacy and tolerability/safety of dexketoprofen trometamol in acute pain states using the best available published scientific evidence (randomized controlled clinical trials and systematic reviews/meta-analyses). METHODS Literature retrieval was performed via Medline, Embase and the Cochrane Library (from inception up to March 2017) using combinations of the terms "randomized controlled trials", "dexketoprofen", "celecoxib", "etoricoxib", "parecoxib" and "acute pain". RESULTS Single-dose dexketoprofen trometamol provides effective analgesia in the treatment of acute pain, such as postoperative pain (dental and non-dental surgery), renal colic, acute musculoskeletal disorders and dysmenorrhea, and reduces opioid consumption in the postoperative setting. It has a rapid onset of action (within 30 minutes) and is well tolerated during short-term treatment. Direct comparisons with COX-2 inhibitors are lacking; however, the efficacy and tolerability of single-dose dexketoprofen trometamol appears to be consistent with that seen with celecoxib, etoricoxib and parecoxib in the acute pain setting. CONCLUSION In conclusion, dexketoprofen trometamol appears to provide similar analgesic efficacy to COX-2 inhibitors when used to treat acute pain, has a rapid onset of action, is well tolerated, and has an opioid-sparing effect when used as part of a multimodal regimen in the acute pain setting.
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Affiliation(s)
- Magdi Hanna
- a Analgesics and Pain Research (APR) , Beckenham, Kent , UK
| | - Jee Y Moon
- b Department of Anesthesiology and Pain Medicine , Seoul National University Hospital College of Medicine and the Integrated Cancer Management Center, Seoul National University Cancer Hospital , Seoul , Korea
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91
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Goodall ID, Bachtold S. Pain Conditions in HIV/AIDS. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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92
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Kaplan S, Ehlken B, Hamann X. The impact of risk minimization measures on compliance and prescribing practices of flupirtine in Germany. Curr Med Res Opin 2019; 35:33-40. [PMID: 29992843 DOI: 10.1080/03007995.2018.1499507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: In response to safety concerns, risk minimization measures (RMM) for flupirtine were implemented in Europe in 2013 to reduce hepatotoxicity risk. This study aims to characterize compliance and prescribing practices of flupirtine before and after RMM implementation.Research design and methods: A retrospective pre-post design cohort study was conducted in the outpatient setting using a longitudinal electronic medical record database in Germany. The study population included patients who initiated flupirtine. One-year pre- and post-implementation periods were assessed.Main outcome measures: Six RMM elements were evaluated, including indication of acute pain, use for maximum of 2 weeks, use when other analgesics are contraindicated, no pre-existing liver disease or alcohol abuse, no concomitant drug induced liver injury, and weekly liver function tests.Results: The number of flupirtine users decreased by 34.4% from 18,291 in the pre-implementation period (2012) to 12,000 in the post-implementation period (April 2015 to March 2016). Elements of RMM with substantial improvement included flupirtine prescription duration, where the proportion of patients with duration ≤14 days increased significantly by 16.5% from 74.8% to 91.3% in the pre- and post-implementation periods, respectively. RMM with a moderate-to-high degree of compliance during the post-implementation period, although with a very small or no change from the pre- implementation period, included restriction of flupirtine prescribing to patients with acute pain when other analgesics are contraindicated, and avoiding use in patients with either pre-existing liver disease or concomitant drugs known to have a potential hepatotoxic effect. Weekly liver function tests had a low degree of compliance.Conclusions: These findings demonstrate that, while physicians restricted flupirtine prescriptions to short-term use in the target population of acute pain, not all drug labeling elements were followed to the same extent in routine practice.
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Affiliation(s)
- Sigal Kaplan
- Teva Pharmaceutical Industries Ltd, Petach Tikva, Israel
| | | | - Xenia Hamann
- Ratiopharm GmbH (an affiliate of Teva Pharmaceuticals Europe BV), Ulm, Germany
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93
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Li Y, Huang K, Cheng Y, Tong Y, Mo J. Pain Management by Nurses in Level 2 and Level 3 Hospitals in China. Pain Manag Nurs 2018; 20:284-291. [PMID: 30425013 DOI: 10.1016/j.pmn.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/01/2018] [Accepted: 08/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management. AIMS To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers. DESIGN This was a cross-sectional descriptive study. SETTING This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015. PARTICIPANTS Subjects: The sample included 121 nurses from China. METHODS Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice. RESULTS Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p < .05) and quality (77.27% vs. 53.85%, p < .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p < .01), conduct pain management knowledge training (88.64% vs. 69.23%, p < .05), and establish pain management regulations (68.18% vs. 34.62%, p < .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p < .05). CONCLUSIONS Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals.
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Affiliation(s)
- Yunxia Li
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kangmao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Cheng
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | - Jian Mo
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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94
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Schnabel A. Acute neuropathic pain and the transition to chronic postsurgical pain. Pain Manag 2018; 8:317-319. [PMID: 30280642 DOI: 10.2217/pmt-2018-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexander Schnabel
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1A, 48149 Muenster, Germany.,Department of Anaesthesiology, University Hospital of Wuerzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
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95
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Redley B, Baker T. Have you SCAND MMe Please? A framework to prevent harm during acute hospitalisation of older persons: A retrospective audit. J Clin Nurs 2018; 28:560-574. [PMID: 30129081 DOI: 10.1111/jocn.14650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To test the mnemonic Have you SCAND MMe Please? as a framework to audit nursing care to prevent harms common to older inpatients. BACKGROUND It is not known if acute hospital care comprehensively addresses eight interrelated factors that contribute to preventable harms common in older hospitalised patients. DESIGN Retrospective audit of medical records. METHODS A random selection of 400 medical records of inpatients over 65 years of age with an unplanned admission of longer than 72 hr in acute medical wards at four hospitals in Victoria, Australia, during 2011-12, was examined for frequency of documented evidence of assessments, interventions or new problems related to eight factors contributing to common preventable harms during hospitalisation. RESULTS Assessments of skin integrity (94%-97%), mobility (95%-98%) and pain (93%-97%) were most often documented. Gaps in assessment of continence (4%-31%), nutrition (9%-49%), cognition (delirium, depression and dementia) (10%-24%) were most common. No patient record had evidence of all eight factors being assessed. Almost 80% of records had interventions documented for one or more factors that contribute to preventable harms. In almost 20% of patient records, a new preventable harm was documented during hospitalisation. CONCLUSIONS The mnemonic Have you SCAND MMe Please? brings together eight factors known to contribute to preventable harms common in older hospitalised patients. This framework was useful to identify gaps in assessment and interventions for factors that contribute to preventable harms during acute hospital care. Future research should test if the mnemonic can assist nurses with comprehensive harm prevention during acute hospitalisation. RELEVANCE TO CLINICAL PRACTICE The mnemonic Have you SCAND MMe Please? represents eight factors that contribute to preventable harms common in older hospitalised patients. This framework provides a model for harm prevention to assist nurses to implement comprehensive harm prevention to improve quality of care and safety for older hospitalised patients.
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Affiliation(s)
- Bernice Redley
- School of Nursing and Midwifery, Nursing Research Centre, Monash Health-Deakin Partnership, Deakin University, Burwood, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
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96
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State of the art analgesia- recent developments in pharmacological approaches to acute pain management in dogs and cats. Part 1. Vet J 2018; 238:76-82. [DOI: 10.1016/j.tvjl.2018.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 01/11/2023]
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97
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Avallin T, Muntlin Athlin Å, Elgaard Sørensen E, Kitson A, Björck M, Jangland E. Person-centred pain management for the patient with acute abdominal pain: An ethnography informed by the Fundamentals of Care framework. J Adv Nurs 2018; 74:2596-2609. [DOI: 10.1111/jan.13739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/03/2018] [Accepted: 06/01/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine; Uppsala University Hospital; Uppsala Sweden
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Department of Public Health and Caring Sciences/Health Services Research; Uppsala University; Uppsala Sweden
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Alison Kitson
- College of Nursing and Health Sciences Flinders University; Adelaide SA Australia
| | - Martin Björck
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - Eva Jangland
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
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98
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Vittinghoff M, Lönnqvist PA, Mossetti V, Heschl S, Simic D, Colovic V, Dmytriiev D, Hölzle M, Zielinska M, Kubica-Cielinska A, Lorraine-Lichtenstein E, Budić I, Karisik M, Maria BDJ, Smedile F, Morton NS. Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative). Paediatr Anaesth 2018; 28:493-506. [PMID: 29635764 DOI: 10.1111/pan.13373] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/21/2022]
Abstract
The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.
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Affiliation(s)
- Maria Vittinghoff
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Per-Arne Lönnqvist
- Paediatric Anaesthesia & Intensive Care, Section of Anaesthesiology & Intensive Care, Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Valeria Mossetti
- Department of Anesthesia and Intensive Care, Regina Margherita Children's Hospital, Torino, Italy
| | - Stefan Heschl
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Dusica Simic
- University Children's Hospital, Medical Faculty University of Belgrade, Serbia
| | - Vesna Colovic
- Royal Manchester Children's Hospital, Central Manchester University Hospitals, Manchester, UK
| | - Dmytro Dmytriiev
- Department of Anesthesiology and Intensive Care, Vinnitsa National Medical University, Vinnitsa, Ukraine
| | - Martin Hölzle
- Section of Paediatric Anaesthesia, Department of Anaesthesia, Luzerner Kantonsspital, Luzern, Switzerland
| | - Marzena Zielinska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kubica-Cielinska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ivana Budić
- Centre for Anesthesiology and Resuscitation, Clinical Centre Nis Department of Anesthesiology, Medical Faculty, University of Nis, Nis, Serbia
| | - Marijana Karisik
- Institute for Children Diseases, Department of Anaesthesiology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Belen De Josè Maria
- Department of Pediatric Anesthesia, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Francesco Smedile
- Department of Pediatric Anesthesiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Neil S Morton
- Paediatric Anaesthesia and Pain Management, University of Glasgow, Glasgow, UK
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99
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Bradbrook C, Clark L. State of the art analgesia-Recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2. Vet J 2018; 236:62-67. [PMID: 29871752 DOI: 10.1016/j.tvjl.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
There has been considerable interest in the area of acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is ever increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The second part of this review will consider the non-traditional analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.
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Affiliation(s)
| | - L Clark
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, SG5 3HR, UK
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100
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Sabab A, Sandhu J, Bacchi S, Jukes A, Zacest A. Postoperative headache following treatment of vestibular schwannoma: A literature review. J Clin Neurosci 2018; 52:26-31. [PMID: 29656878 DOI: 10.1016/j.jocn.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 01/04/2023]
Abstract
Vestibular schwannoma (VS) is a brain tumour arising from Schwann cells that is typically closely associated with the vestibulocochlear nerve. Post-operative headaches (POH) are a potentially common complication of surgery for VS. Greatly differing rates of POH have previously been reported, particularly with different surgical approaches. The aim of this review is to identify and summarise the available peer-reviewed evidence on rates of POH following operative (or radiosurgery) treatment for VS, in addition to information about the treatment and prognosis of POH in these patients. A systematic search was conducted of Pubmed, Medline, Scopus and EMBASE in April 2017 using the medical subject headings (acoustic neuroma OR vestibular schwannoma) AND headache. Eligibility determination and data extraction were performed in duplicate with standardised forms. POH is common following surgery for VS. Differing rates of POH have been reported with different management approaches, patient age and tumour size. There are relatively few studies that have directly compared the rates of POH with different surgical approaches. The retrosigmoid approach with craniotomy appears to have lower rates of POH than when the retrosigmoid approach is performed with craniectomy. Patients under the age of 65 and with tumours <1.5 cm in size appear to have a higher risk of POH. The most commonly documented management of POH involves simple analgesia, although the majority of patients report this treatment is of only minimal benefit. Further prospective studies comparing rates of POH following different surgical approaches and radiosurgery are required.
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Affiliation(s)
- Ahad Sabab
- Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - Jaspreet Sandhu
- Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Alistair Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
| | - Andrew Zacest
- Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
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