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Mori M, Ikeda E, Fujita K. Validation of the Japanese version of Algoplus® for the assessment of acute postoperative pain in older patients with cancer. Jpn J Nurs Sci 2024; 21:e12623. [PMID: 39291590 DOI: 10.1111/jjns.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/17/2024] [Accepted: 08/03/2024] [Indexed: 09/19/2024]
Abstract
AIM This study aimed to validate a Japanese version of the Algoplus® tool by assessing postoperative pain in older Japanese patients with cancer and examining the scale's psychometric properties. METHODS After translating Algoplus® into Japanese, we conducted a cross-sectional study of patients aged 65 years or older who underwent surgery to remove malignant tumors. Two registered nurse-certified investigators used the Numerical Rating Scale, the Japanese version of Algoplus®, and the Japanese version of the Abbey Pain Scale before and after analgesic use on postoperative days 3 and 5 to evaluate response to pharmacologic therapy. Validity was tested by a correlation analysis between the Japanese version of Algoplus®, two pain scales, and nine hypotheses related to demographic variables and surgical invasions. The Kuder-Richardson-20 test and Cohen's Kappa coefficient were used for internal consistency and inter-rater reliability, respectively. RESULTS The total score of the Japanese version of Algoplus® showed strong to moderate correlations with the two pain scales. Demographic characteristics were not associated with the total score of the Japanese version, but significant correlations with operative time and postoperative analgesia administration existed. The scale demonstrated good internal consistency (Kuder-Richardson-20 α: .70) and inter-rater reliability (Kappa coefficient .72). The total score of the Japanese version decreased significantly after analgesic use in both postoperative assessments. CONCLUSIONS The Japanese version of Algoplus® is a reliable and valid instrument for nurses to easily assess acute postoperative pain in older Japanese patients with cancer and shows good responsiveness for detecting the change in pain status.
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Affiliation(s)
- Masumi Mori
- Department of Health Sciences, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
- Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Eri Ikeda
- Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Kimie Fujita
- Department of Health Sciences, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
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2
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Periañez CAH, Castillo-Diaz MA, Barbosa MH, De Mattia AL. Pain Predictors in Patients in the Postanesthesia Care Unit. J Perianesth Nurs 2024; 39:652-658. [PMID: 38310508 DOI: 10.1016/j.jopan.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE To analyze the effects of pain-predicting factors on patients in the postanesthesia care unit (PACU). DESIGN This is an observational and prospective study. METHODS This study was conducted at a University Hospital in the state of Minas Gerais (Brazil). To collect data on demographic, clinical, and surgical factors, a collection instrument was devised. The verbal numerical scale was employed to measure pain levels before and after surgery in the PACU. A path analysis was used to assess a predictive model. FINDINGS A total of 226 patients were included in this study. The incidence of pain in the PACU was 31.9%. A model with demographic, clinical, and surgical variables was tested. The final model, after including modification indices, obtained results that indicated an acceptable data fit (comparative fit index = 0.996; root mean square error of approximation = 0.08). Age (being young), sex (being a woman), oncological diagnosis as an indication for the surgical procedure, type of surgery (surgery of the digestive system), duration of surgery (longer surgeries), and high intraoperative doses of opioids were predictive variables for pain in the PACU. CONCLUSIONS This study's findings provide support for pain management in the PACU. Furthermore, the results of this research can be used to anticipate the occurrence of acute postoperative pain and personalized perioperative analgesia needs.
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Affiliation(s)
| | - Marcio Alexander Castillo-Diaz
- Universidad Nacional Autónoma de Honduras, Vicerrectoría de Orientación y Asuntos Estudiantiles. Tegucigalpa, Francisco Morazán, Honduras
| | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar. Uberaba, Minas Gerias, Brasil
| | - Ana Lúcia De Mattia
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Básica, Belo Horizonte, Minas Gerais, Brasil
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3
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Kim K, Choi S, Park M, Kim J, Kim K, Song E, Kim N, Park S, Song Y. Development of an Acute Pain Assessment Tool for Patients in Post-anesthesia Care Units. Pain Manag Nurs 2024; 25:e93-e98. [PMID: 38135607 DOI: 10.1016/j.pmn.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Post-operative pain is a common form of acute pain. Objective pain assessment in post-anesthesia care units after surgery is useful regardless of the patient's condition. AIMS This study aimed to develop and evaluate an acute pain assessment tool for patients in post-anesthesia care units. DESIGN This was a cross-sectional observational study comprising two stages: scale development and psychometric evaluation. SETTINGS . PARTICIPANTS/SUBJECTS . METHODS Scale items were developed based on a literature review and content validity by experts. The validity and interrater reliability of the pain scale were evaluated using data from 218 patients admitted to the post-anesthesia care unit at a university hospital. A receiver operating characteristic curve was used to identify the sensitivity and specificity for determining the cutoff point for acute pain. RESULTS We developed an objective acute pain scale, called the APA5, which ranges from 0-10 and comprises behavioral (facial and verbal expressions and body movement) and physiological (changes in heart rate and blood pressure) responses. The APA5 is valid and reliable for assessing acute pain in the recovery room. Sensitivity and specificity were acceptable when the cutoff was 2 out of 10 points. CONCLUSIONS The APA5 is an easy and simple tool for measuring pain in patients in post-anesthesia care units who have difficulties with self-reporting.
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Affiliation(s)
- Kyoungsook Kim
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Suna Choi
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Myouyun Park
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Junghee Kim
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kwanghee Kim
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Eunjin Song
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Nagyeong Kim
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Seyeon Park
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea; College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
| | - Youngshin Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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Beaudoin M, Belzile EL, Gélinas C, Trépanier D, Émond M, Gagnon MA, Bérubé M. Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study. Int J Orthop Trauma Nurs 2024; 52:101050. [PMID: 37848364 DOI: 10.1016/j.ijotn.2023.101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited. AIMS To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation. METHODS A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken. RESULTS A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes. CONCLUSIONS Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact.
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Affiliation(s)
- Maryline Beaudoin
- Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada.
| | - Etienne L Belzile
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Orthopaedic Surgery, CHU de Quebec- Laval University, Quebec, QC, Canada
| | - Céline Gélinas
- Quebec Pain Research Network, Sherbrooke, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Montreal, QC, Canada; Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - David Trépanier
- Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marcel Émond
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marc-Aurèle Gagnon
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada
| | - Mélanie Bérubé
- Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada
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Huang L, Xia B, Cheng L, Hu XW, Zheng LD, Cheng F. Use of a combination of diaphragmatic ultrasound and muscle relaxation monitoring in predicting post-extubation adverse respiratory events among elderly patients in an anesthesia intensive care unit. BMC Pulm Med 2023; 23:503. [PMID: 38087209 PMCID: PMC10717864 DOI: 10.1186/s12890-023-02791-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the feasibility of using a combination of diaphragmatic ultrasound and muscle relaxation monitoring in predicting adverse respiratory events after extubation among elderly patients in an anesthetic intensive care unit (AICU). METHODS The study participants were 120 elderly patients who were in the AICU after laparoscopic radical resection for colorectal cancer. Based on whether there were critical respiratory events (CREs) after extubation, they were divided into the adverse event group and the non-adverse event group. We used logistic regression to identify factors influencing the occurrence of CREs post-extubation in elderly patients. Using the receiver operating characteristic (ROC) curve, we analyzed the value of each indicator in predicting CREs post-extubation. RESULTS We included 109 patients in the final analysis. In the adverse event group (n = 19), the age, proportion of females, and proportion of preoperative respiratory diseases were higher than in the non-adverse event group (n = 90). The muscle relaxation value, quiet breathing diaphragmatic excursion during extubation (DE-QB), deep breathing diaphragmatic excursion during extubation (DE-DB), and deep breathing diaphragmatic thickening fraction during extubation (DTF-DB) of patients in the adverse event group were significantly lower than those in the non-adverse event group (P < 0.05). Using binary logistic regression analysis, we identified muscle relaxation value, DE-DB, and DTF-DB during extubation as significant predictors of CREs post-extubation in elderly patients (P < 0.05). The area under the curve (AUC) of the combination of the muscle relaxation value, DE-DB, and DTF-DB during extubation for predicting CREs after extubation in elderly patients was 0.949, which was higher than that of any single indicator. CONCLUSION The combination of diaphragmatic ultrasound and muscle relaxation monitoring was more accurate in predicting CREs post-extubation among elderly patients in the AICU.
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Affiliation(s)
- Lun Huang
- Graduate Department, Bengbu Medical College, Bengbu, 233030, China
| | - Bo Xia
- Graduate Department, Bengbu Medical College, Bengbu, 233030, China
| | - Lei Cheng
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, No. 21 of Wanxi West Road, Lu'an, 237005, China
| | - Xian-Wen Hu
- Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Li-Dong Zheng
- Graduate Department, Bengbu Medical College, Bengbu, 233030, China.
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, No. 21 of Wanxi West Road, Lu'an, 237005, China.
| | - Feng Cheng
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, No. 21 of Wanxi West Road, Lu'an, 237005, China.
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Aglio LS, Mezzalira E, Corey SM, Fields KG, Hauser BM, Susano MJ, Culley DJ, Schreiber KL, Kelly-Aglio NJ, Patton ME, Mekary RA, Edwards RR. Does the Association Between Psychosocial Factors and Opioid Use After Elective Spine Surgery Differ by Sex in Older Adults? J Pain Res 2023; 16:3477-3489. [PMID: 37873025 PMCID: PMC10590566 DOI: 10.2147/jpr.s415714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/01/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose Psychosocial disorders have been linked to chronic postoperative opioid use and the development of postoperative pain. The potential interaction between sex and psychosocial factors with respect to opioid use after elective spine surgery in the elderly has not yet been evaluated. Our aim was to assess whether any observed association of anxiety or depression indicators with opioid consumption in the first 72 hours after elective spine surgery varies by sex in adults ≥65 years. Patients and Methods Secondary analysis of a retrospective cohort of 647 elective spine surgeries performed at Brigham and Women's Hospital, July 1, 2015-March 15, 2017, in patients ≥65. Linear mixed-effects models were used to test whether history of anxiety, anxiolytic use, history of depression, and antidepressant use were associated with opioid consumption 0-24, 24-48, and 48-72 post surgery, and whether these potential associations differed by sex. Results History of anxiety, anxiolytic use, history of depression, and antidepressant use were more common among women (51.3% of the sample). During the first 24 hours after surgery, men with a preoperative history of anxiety consumed an adjusted mean of 19.5 morphine milligram equivalents (MME) (99.6% CI: 8.1, 31.0) more than men without a history of anxiety; women with a history of anxiety only consumed an adjusted mean 2.9 MME (99.6% CI: -3.1, 8.9) more than women without a history of anxiety (P value for interaction between sex and history of anxiety <0.001). No other interactions were detected between sex and psychosocial factors with respect to opioid use after surgery. Conclusion Secondary analysis of this retrospective cohort study found minimal evidence that the association between psychosocial factors and opioid consumption after elective spine surgery differs by sex in adults ≥65.
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Affiliation(s)
- Linda S Aglio
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elisabetta Mezzalira
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Sarah M Corey
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Blake M Hauser
- Harvard-Massachusetts Institute of Technology Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Maria J Susano
- Department of Anesthesiology, Emergency and Critical Care, Centro Hospitalar do Porto, Porto, Portugal
| | - Deborah J Culley
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nicole J Kelly-Aglio
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Megan E Patton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rania A Mekary
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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7
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Lutfallah S, Wajid I, Sinnathamby ES, Maitski RJ, Edinoff AN, Shekoohi S, Cornett EM, Urman RD, Kaye AD. Low-Level Laser Therapy for Acute Pain: A Comprehensive Review. Curr Pain Headache Rep 2023; 27:607-613. [PMID: 37578732 DOI: 10.1007/s11916-023-01149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE OF REVIEW An analysis of data conducted in 2015 by the National Health Interview Survey (NHIS) found that an estimated 25.3 million adults (11.2%) have experienced pain every day for the preceding 3 months, and nearly 40 million adults (17.6%) have experienced a severe level of pain. RECENT FINDINGS Multiple reviews have analyzed the current management of acute pain; however, much of the current literature only focuses on pharmacological methods of analgesia, such as opiates, ketamine, or non-steroidal anti-inflammatory drugs (NSAIDs). Publications that discuss non-pharmacological options often criticize the limitations of available research for these therapies, making further exploration of this type of treatment necessary. The present investigation aims to summarize current knowledge on the use of low-level laser therapy (LLLT), a cold laser non-pharmacological approach, in managing acute pain and to discuss important clinical findings and considerations when it comes to utilizing this treatment option in patients.
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Affiliation(s)
- Salim Lutfallah
- School of Medicine, Louisiana State University, New Orleans, New Orleans, LA, 70112, USA
| | - Irza Wajid
- Louisiana State University Health Science Center New Orleans, 1900 Perdido Street, New Orleans, LA, 70115, USA
| | - Evan S Sinnathamby
- LSUHSC-New Orleans School of Medicine, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Rebecca J Maitski
- LSUHSC-New Orleans School of Medicine, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Amber N Edinoff
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Ohio State University Health Sciences Center, The Ohio State University, N437 Doan Hall, 410 W. 10Th Avenue, Columbus, OH, 43210, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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Hosseini F, Mullins S, Gibson W, Thake M. Acute pain management for older adults. Clin Med (Lond) 2022; 22:302-306. [PMID: 35882483 DOI: 10.7861/clinmed.22.4.ac-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Older adults may experience a number of physiological changes that influence how acute pain is perceived, diagnosed and managed by healthcare professionals. Understanding these differences enables the identification, assessment and treatment of acute pain in older adults. Combining careful selection of pain medications with appropriate titration and monitoring allows the analgesic needs of this group to be met.
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Affiliation(s)
- Faroakh Hosseini
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sophie Mullins
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Miriam Thake
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
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Mullins S, Hosseini F, Gibson W, Thake M. Physiological changes from ageing regarding pain perception and its impact on pain management for older adults. Clin Med (Lond) 2022; 22:307-310. [PMID: 35882493 DOI: 10.7861/clinmed.22.4.phys] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Physiological changes that occur during ageing can affect the incidence, experience and treatment of pain in older adults. This article reviews these physiological changes and how they can affect the best approach to management.
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Affiliation(s)
- Sophie Mullins
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Faroakh Hosseini
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Miriam Thake
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
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Abstract
Pain and related disability remain a major social and therapeutic problem. Comorbidities and therapies increase drug interactions and side effects making pain management more compounded especially in the elderly who are the fastest-growing pain population. Multimodal analgesia consists of using two or more drugs and/or techniques that target different sites of pain, increasing the level of analgesia and decreasing adverse events from treatment. Paracetamol enhances multimodal analgesia in experimental and clinical pain states. Strong preclinical evidence supports that paracetamol has additive and synergistic interactions with anti-inflammatory, opioid and anti-neuropathic drugs in rodent models of nociceptive and neuropathic pain. Clinical studies in young and adult elderly patients confirm the utility of paracetamol in multimodal, non-opioid or opioid-sparing, therapies for the treatment of acute and chronic pain.
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Affiliation(s)
- Ulderico Freo
- Anesthesiology & Intensive Medicine, Department of Medicine - DIMED, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
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11
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Kwon OS, Kwon BK, Kim JH, Kim BH. Effects of heating therapy on pain, anxiety, physiologic measures, and satisfaction in patients undergoing cystoscopy. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:73-79. [DOI: 10.1016/j.anr.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/02/2022] Open
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Yip T, Hu J, Hawn PS, Yamamoto A, Oderda G. HTX-011 effectively reduces postoperative pain intensity and opioid use in the elderly. Pain Manag 2021; 12:45-57. [PMID: 34284613 DOI: 10.2217/pmt-2021-0043] [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: 12/23/2022] Open
Abstract
Aim: HTX-011 (ZYNRELEF™) is an extended-release, dual-acting local anesthetic containing bupivacaine and meloxicam. In bunionectomy and herniorrhaphy studies, HTX-011 resulted in less postoperative pain and less opioid consumption versus bupivacaine HCl. Here we evaluate HTX-011 in patients aged ≥65 years. Materials & methods: Patients received placebo, bupivacaine HCl or HTX-011 following surgery. End points included pain intensity, total opioid consumption, opioid-free patients and safety. Results: HTX-011-treated patients reported lower postoperative pain through 72 h versus bupivacaine HCl and placebo. Elderly patients administered HTX-011 used fewer opioids versus bupivacaine HCl, and a greater proportion remained opioid-free through 72 h. HTX-011 was well tolerated with a safety profile similar to bupivacaine HCl and placebo. Conclusion: HTX-011 maintained effectiveness and was well tolerated in elderly patients. Clinical Trial Registration: NCT03295721 and NCT03237481.
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Affiliation(s)
- Tina Yip
- Department of Pharmacy, Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Jia Hu
- Heron Therapeutics, Inc., 4242 Campus Point Court, Suite 200, San Diego, CA 92121, USA
| | - Pamela S Hawn
- Heron Therapeutics, Inc., 4242 Campus Point Court, Suite 200, San Diego, CA 92121, USA
| | - Amy Yamamoto
- Heron Therapeutics, Inc., 4242 Campus Point Court, Suite 200, San Diego, CA 92121, USA
| | - Gary Oderda
- University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT 84112, USA
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13
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Haines KL, Fuller M, Antonescu I, Vaughan JG, Raghunathan K, Cox CE, Bartz RR, Ohnuma T, Agarwal S, Krishnamoorthy V. Underutilization of Acetaminophen in Older Adult Trauma Patients. Am Surg 2021; 88:2003-2010. [PMID: 34049451 DOI: 10.1177/00031348211023397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Older adults are more vulnerable to opioid-associated morbidity. The purpose of this study was to determine the frequency and timing of acetaminophen and opioid use in the postoperative period. METHODS Older adult trauma patients (≥65 years) with hip fractures requiring femur or hip fixation were reviewed (Premier Database 2008-2014). We examined rates of acetaminophen use on the day of surgery and prior to receipt of oral opioids. Mixed-effects linear regression models were used to examine the effects of an acetaminophen-first approach on opioid use the day prior to and on the day of discharge. RESULTS Of the 192 768 patients, 81.6% were Caucasian; 74.0% were female; and the mean age was 82.0 years [± 7.0]. Only 16.8% (32 291) of patients received acetaminophen prior to being prescribed opioids. 27.4% (52 779) received an acetaminophen-opioid combination, and 9.2% (17 730) received opioids without acetaminophen first. Acetaminophen first was associated with reduced opioid use on the day prior to and on the day of discharge (3.52 parenteral morphine equivalent doses (PMEs) less [95% CI: 3.33, 3.70]; P < .0001). A statistically but not clinically significant reduction in length of stay was observed in the acetaminophen-first group. CONCLUSION Nearly 37% of older adult patients did not receive acetaminophen as first-line analgesia after hip surgery. Multimodal analgesia, including non-opioid medications as first-line, should be encouraged.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.,The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Matthew Fuller
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Ioana Antonescu
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.,The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Justin G Vaughan
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Christopher E Cox
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Raquel R Bartz
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Suresh Agarwal
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.,The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
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Moore L, Norwood C, Stackhouse R, Nguyen K, Brown W, Sevak RJ. Gabapentin reduces postoperative pain and opioid consumption in patients who underwent lumbar laminectomy. J Am Pharm Assoc (2003) 2021; 61:e78-e83. [PMID: 34024754 DOI: 10.1016/j.japh.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative pain management solely with opioids elevates the risk of opioid-related adverse events during hospitalization and after discharge from the hospital. Clinical trials have demonstrated gabapentinoids as viable adjunctive treatments for spinal surgeries. However, only a few practice-based studies have examined the efficacy of gabapentin as an opioid-sparing agent for patients undergoing lumbar laminectomy in rural hospital settings. OBJECTIVE To determine the effects of gabapentin on opioid consumption and pain perception in patients who underwent lumbar laminectomy at a rural community hospital. METHODS Data were collected by retrospective chart reviews of 99 patients who underwent lumbar laminectomy at Yavapai Regional Medical Center from January 1, 2017, to July 1, 2019. The patients were stratified into 2 groups: those who were taking gabapentin as outpatients before surgery and were continued on the same dose postoperatively (n = 50, gabapentin group) and those who were not taking gabapentin preoperatively or postoperatively (n = 49, usual-treatment group). The primary end points were opioid consumption in morphine milligram equivalents (MME) and pain for 24 hours postsurgery. RESULTS Outcomes from the mixed-model analysis of variance showed significant main effects of group and time for opioid consumption in MME (F1,97 = 4.3, P < 0.05 and F3,291 = 133.9, P < 0.001, respectively) and numerical pain scale scores (F1,99 = 4.0, P < 0.05 and F3,241 = 21.4, P < 0.001, respectively) and group-time interaction for opioid consumption in MME (F3,291 = 2.6, P = 0.05). Post hoc analyses showed that opioid consumption in MME was significantly lower in the gabapentin group than in the usual-treatment group for the first 6 hours postoperatively. The pain scores were significantly lower in the gabapentin group than in the usual-treatment group across all time periods. CONCLUSION Patients on gabapentin showed reductions in pain perception and postoperative opioid consumption. The results extend the findings from randomized trials to a real-world clinical setting. These data support using gabapentin in conjunction with opioids for pain management of patients undergoing lumbar laminectomy.
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Clare D, Zink KL. Geriatric Trauma. Emerg Med Clin North Am 2021; 39:257-271. [PMID: 33863458 DOI: 10.1016/j.emc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Geriatric trauma patients will continue to increase in prevalence as the population ages, and many specific considerations need to be made to provide appropriate care to these patients. This article outlines common presentations of trauma in geriatric patients, with consideration to baseline physiologic function and patterns of injury that may be more prevalent in geriatric populations. Additionally, the article explores specific evidence-based management practices, the significance of trauma team and geriatrician involvement, and disposition decisions.
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Affiliation(s)
- Drew Clare
- Department of Emergency Medicine, University of Florida, 655 W 8th st, Jacksonville, FL 32209, USA.
| | - Korie L Zink
- Johns Hopkins University, 1830 E. Monument St, St 6-100, Baltimore, MD 21224, USA. https://twitter.com/koriezinkmd
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Comparison of ibuprofen and piroxicam gel in the treatment of trauma pain: A randomized double-blind trial of geriatric population. Am J Emerg Med 2020; 38:2110-2115. [PMID: 33041145 DOI: 10.1016/j.ajem.2020.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to compare the analgesic efficacy of topical ibuprofen and topical piroxicam for acute musculoskeletal injuries. METHODS In this prospective, randomized, controlled, double-blinded study, geriatric patients were assigned to groups to receive either topical ibuprofen (n = 70) or topical piroxicam (n = 69). The first dose of gel was applied in the emergency department and the remaining doses were self-administered at home by the patients thrice daily for 72 h. For each patient, the initial baseline visual analog scale (VAS) score (V 0) was compared with the VAS scores at the 60 min (V1), 120 min (V2), 24 h (V3) and 72 h (V4) time points. The decreases in VAS scores, clinical effectiveness of the treatments, and incidence of adverse events were evaluated. RESULTS In the topical ibuprofen group, the VAS scores were significantly lower at each measurement time point compared to baseline (p < .001). The results were as follows: V0 -V: 1.08, 95% CI: 0.56-1.61; V0 -V2: 1.09, 95% CI: 0.49-1.69; V0 -V3: 1.44, 95% CI: 0.81-2.07; V0 -V4: 1.59, 95% CI: 0.91-2.26. The mean percentage decrease in the VAS scores in the topical ibuprofen group was significantly higher than that in the topical piroxicam group (p < .001). The clinical effect of treatment was found to be significantly higher for the ibuprofen gel group (p < .001). There was no substantial difference in treatment-related adverse events between the groups (p > .05). CONCLUSION Ibuprofen gel, which is a safe treatment option for geriatric patients, is more clinically effective than piroxicam gel. Response to Reviewers.
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Haines KL, Fuller M, Vaughan JG, Krishnamoorthy V, Raghunathan K, Kasotakis G, Agarwal S, Ohnuma T. The Impact of Nonsteroidal Anti-inflammatory Drugs on Older Adult Trauma Patients With Hip Fractures. J Surg Res 2020; 255:583-593. [PMID: 32650142 DOI: 10.1016/j.jss.2020.05.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug (NSAID) use is frequently recommended for multimodal analgesia to reduce opioid use. We hypothesized that increased NSAID utilization will decrease opioid requirements without leading to significant complications in older adult trauma patients undergoing hip fracture repair. METHODS An observational cross-sectional cohort study of 190,057 adult trauma patients over a 6-y period (2008-2014) in the national Premier Healthcare Database was performed. Patients aged 65 or older undergoing femur repair and hip arthroplasty following fractures due to falls were analyzed. Primary outcome was opioid use, and secondary outcomes included transfusion requirements, length of stay (LOS), and organ system dysfunction. Continuous outcomes were analyzed using mixed-effect linear regression models to assess the effect of NSAIDs on the day of surgery. Fixed effects were included for patient and hospital characteristics, comorbidities, co-treatments, and surgery. Random intercepts for each hospital were included to control for clustering. Categorical outcomes were similarly analyzed using mixed-effect logistic regression models. RESULTS NSAIDs decreased opioids prescribed (12.01 versus 11.43 morphine milligram equivalents) (odds ratio [OR], -0.23; confidence interval [CI] = -0.41, -0.06) without overall increased bleeding (40.83% versus 43.18%; OR, 1.02; CI = 0.99, 1.05). NSAIDs were associated with reduced LOS (5.61 versus 5.96 d; CI = -0.24, -0.12), intensive care unit admissions (9.73% versus 10.59%; OR, 0.91; CI = 0.86, 0.96), and pulmonary complications (OR, 0.88; CI = 0.83, 0.93). Additionally, there was a 21% prescribing variability based solely on hospital. CONCLUSIONS NSAIDs were associated with decreased opioid requirements, hospital LOS, and intensive care unit admissions in older adult trauma patients without overall increase in bleeding. NSAIDs should be considered in multimodal pain regimens, moreover, given prescribing variability guidelines are needed. LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina.
| | - Matthew Fuller
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina; Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Justin G Vaughan
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - George Kasotakis
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Suresh Agarwal
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina; Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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