Improvements and difficulties in postoperative pain management

BACKGROUND

This review examines postoperative pain (POP) management from the perspectives of healthcare providers, patients, and institutions. It summarizes current thought about POP, including difficulties and recent improvements in the field.

METHODS

Studies were identified from PubMed, MEDLINE, and the search engine Google Scholar and by hand-searching reference lists from review articles and research papers (1998-2009). The search was limited to articles published in the English language. Given the broad review of POP, a complete review of all the potential articles was not possible. Thus, an inclusion criterion was defined, and we retrieved only those studies that included the term postoperative pain treatment, together with 1 or more of the following terms: adult patients, education, interdisciplinary teams, attitudes, physicians, and nurses. Two hundred twenty studies were retrieved, and 93 studies were sufficiently close to the topic of this review. They were organized according to the following themes: POP management as it relates to healthcare providers, patients, and institutions; changing trends in healthcare education in relation to various POP interventions; and the role of policy makers concerning improvements and challenges in the management of POP.

RESULTS

Interdisciplinary teams are needed to implement multimodal methods to treat POP in ways that will provide patients with interventions that will improve their ability to cope with the physical and psychosocial aspects of POP. This is hindered by a lack of hospital financial resources, a lack of educational programs, a lack of knowledge regarding diverse pharmacological options, and lingering negative attitudes toward certain treatments, especially opioids.

CONCLUSIONS

Successful POP management depends on providers' receiving education and information. Policy makers and organizations are called upon to actively intervene by formulating programs and promoting a feedback system, or else POP will remain a neglected issue.

Pharmacological pain control for human immunodeficiency virus-infected adults with a history of drug dependence

Clinicians treating human immunodeficiency virus (HIV)-infected patients with substance use disorders often face the challenge of managing patients' acute or chronic pain conditions while keeping in mind the potential dangers of prescription opiate dependence. In this clinical review, we critically appraise the existing data concerning barriers to appropriate treatment of pain among HIV-infected patients with substance use disorders. We then analyze published studies concerning the choice of pharmacological pain control regimens for acute and chronic pain conditions in HIV-infected patients, keeping in mind HIV-specific issues related to drug interactions and substance use disorders. We summarize this information in the form of flowcharts for physicians approaching HIV-infected patients who present with complaints of pain, providing evidence-based guidance for the structuring of pain management services and for addressing aberrant drug-taking behaviors.

A Practical Approach to Headache Treatment

The World Health Organization cites migraine headache as one of the 20 most disabling medical conditions. This article focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. This review begins with the warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described. Although many individuals believe their headaches are “sinus,” or “stress or tension-induced,” most of the characteristics of these types of headaches actually meet International Headache Society criteria for migraine. Treatments of primary headaches, including acute therapies, abortive agents, and prophylactic medications, are uniquely specific for each headache syndrome. Chronic daily headache patients compose only 4% of the population yet make up the largest percentage of patients who seek treatment at specialty headache centers. Medication-overuse headache, the syndrome in which medications taken for the relief of headache actually foster future headaches, offers a particular challenge to health care providers, as does narcotic use in headache therapy. Complementary and alternative treatments proven efficacious in the treatment of primary headache are also described.