Articles: pain-management-methods.
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The entire field of medicine, not just anesthesiology, has grown comfortable with the risks posed by opioids; but these risks are unacceptably high. It is time for a dramatic paradigm shift. ⋯ Furthermore, there are a myriad of alternative analgesic strategies that provide superior analgesia, decrease recovery time, and have fewer side effects and risks associated with their use. In this article the negative consequences of opioid use for pain, appropriate alternatives to opioids for analgesia, and the available evidence in pediatric populations for both are described.
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Palliative medicine · Jun 2019
Case ReportsShould we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report.
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. ⋯ This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
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To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. ⋯ Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.
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Clinical Trial
Decreasing Pain Ratings in Chronic Arm Pain Through Changing a Virtual Body: Different Strategies for Different Pain Types.
Modifying the visual aspect of a virtual arm that is felt as one's own using immersive virtual reality (VR) modifies pain threshold in healthy subjects, but does it modify pain ratings in chronic pain patients? Our aim was to investigate whether varying properties of a virtual arm co-located with the real arm modulated pain ratings in patients with chronic arm/hand pain because of complex regional pain syndrome (CRPS) type I (without nerve injury) or peripheral nerve injury (PNI). CRPS (n = 9) and PNI (n = 10) patients were immersed in VR and the virtual arm was shown at 4 transparency levels (transparency test) and 3 sizes (size test). We evaluated pain ratings throughout the conditions and assessed the virtual experience, finding that patients with chronic pain can achieve levels of ownership and agency over a virtual arm similar to healthy participants. ⋯ We discuss this through the interactions between body image and pain perception. PERSPECTIVE: "Embodiment" in VR is useful to decrease pain ratings in chronic pain patients, but the best strategy needs to be tuned to the pain etiology. This approach could potentially help patients with chronic pain and clinicians who seek alternatives to pain management for patients.
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A single-blind crossover study. ⋯ The study was funded by Seoul National University Hospital (No. 0420160470) and Korea Workers' Compensation & Welfare Service.