From SIMPAR to CIMPARC: the evolution of international pain research and management

Pain, the uknown: epistemological issues and related clinical implications

Despite the huge development of pain management in the past decades, pain remains elusive and many patients still remain in the middle of the ford struggling between low drug efficacy and their overuse. A reason for pain elusiveness is its nature of subjective phenomenon, escaping the meshes of the objectivist, mechanist-reductionist net prevailing in medicine. Actually, pain is not only a symptom but an essential aspect of life, consciousness and contact with the world and its noetic and autonoetic components play a key role in the development of the concepts of pleasure-unpleasure and good-evil. The intensity and tolerability of pain and suffering also depends on what the pain means to the patient. The outstanding effects of placebo and nocebo, behavioral and non-pharmacological techniques warrant the need for a shift from the traditional positivist idea of patient as passive carrier of disease to the patient as active player of recovery and move toward a patient's centered approach exploiting individual resources for recovery. Among the mentioned techniques, hypnosis has proved to increase pain threshold up to the level of surgical analgesia, improve acute and chronic pain as well as coping and resilience, helping to decrease both drug overuse and the costs of pharmacological therapy. The wealth of available data suggest the need for a holistic approach, aiming to take care of the individual as an inseparable mind-body unit in its interplay with the environment, where patient's inner world, his/her experience and cognition are taken into due account as powerful resources for recovery through a phenomenological-existential approach.

A specially designed medical screen for children suffering from burns: A randomized trial of a distraction-type therapy

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The current study is the first to explore the medical screen as a treatment to control the pain and its related psychological symptoms on children suffering from burns;.

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Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients -ages 1–3 who require dressing changes.

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The medical screen is likely a feasible, acceptable and potentially efficacious treatment option for burns medical workers.

Objective

To evaluate the impact of the specially designed medical dressing screen during wound dressing changes of children who suffered burns to their hand or foot.

Design

Randomized controlled trial.

Setting

Burns and Plastic Reconstruction Unit.

Participants

Children (NN = 120) with burns on up to 1%-–5% of the total body surface area.

Interventions

The patients were selected and randomly allocated to 3 equal-sized groups as follows:control group (N control group (N = 40): the children received only regular dressing changes; computer group (NN = 40): a touch-screen computer was used for children during dressing changes; medical screen group (NN = 40): a medical screen combined with the touch-screen computer were used for children during dressing changes. All patients underwent a dressing change once per day for four days. Data were distributed four times: immediately after the initial dressing change (T1); and immediately after each times at next three consecutive days (T2-T4).Main Outcome M–T4).

Main outcome measures

The Pain level of the children evaluated by medical staffs was the primary outcome, the Pain level of the children evaluated by children's parents and the satisfaction of wound therapist were used as second outcomes.

Results

The mean scores related to pain level at the medical screen group displayed significantly better results than those of control group and those of the computer group. Additionally, the results of the pain evaluated by parents and satisfaction score of the wound therapist at the medical screen group was also better than other groups.

Conclusions

This study demonstrated “that the” application of the medical screen for burns can relieve the pain of 1-–3 years old children suffering from a burns during dressing changes. Additionally, the application of the medical screen also increased the satisfaction of the parents and the wound therapist performing the dressing changes.

Impact of orally administered tramadol combined with self-selected music on adult outpatients with burns undergoing dressing change: A randomized controlled trial

OBJECTIVE

To investigate the effects of music and/or tramadol on pain and anxiety in burn outpatients undergoing dressing changes.

DESIGN

Randomized controlled trial.

SETTING

Burns and Plastic Reconstruction Unit.

PARTICIPANTS

Patients (N=180) with burns on up to 10%-30% of the total body surface area (TBSA).

INTERVENTIONS

The patients were randomly allocated to 4 equal-sized groups as follows: (1) tramadol group (TG), patients received 100mg of tramadol orally 20min before the dressing change; (2) music group (MG), patients listened to self-selected music during the dressing change; (3) music-plus-tramadol group (MTG), patients received tramadol and listened to self-selected music; and (4) control group (CG), patients received a routine dressing change only. All patients underwent the interventions once per day for 2days.

MAIN OUTCOME MEASURES

McGill Pain Questionnaire Short Form (MPQ-SF) (primary outcome), McGill Pain Persian version of Burn Specific Pain Anxiety Scale (BSPAS) (primary outcome), and heart rate (HR) and overall patient satisfaction (secondary outcomes).

RESULTS

The results showed that music-plus-tramadol group (MTG) had better outcomes with respect to pain and anxiety management during dressing changes.

CONCLUSIONS

In comparison with music or tramadol alone, the integration of music and tramadol offers a secure and favorable treatment choice to relieve pain and anxiety, ultimately improving the satisfaction levels of burn outpatients during dressing changes.