Articles: pain-management-methods.
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A best evidence topic was written according to a structured protocol. The question addressed whether local anaesthetic infiltration of the transversus abdominis plane (TAP block) during a laparoscopic cholecystectomy improves pain control. Ten papers were found using the reported search, of which four represented the best evidence to answer the clinical question. ⋯ Three of the randomised controlled trials demonstrated a reduction in analgesic requirements associated with TAP blocks following laparoscopic cholecystectomy as compared to placebo. The remaining randomised study compared TAP blocks with local anaesthetic infiltration of laparoscopic port sites and showed no significant difference in clinical outcomes between these two techniques. We conclude that there is good evidence that TAP block in laparoscopic cholecystectomy leads to a reduction in pain scores and analgesic requirement, however there is no significant difference when compared to local anaesthetic infiltration of trocar insertion sites.
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Despite advances made in its understanding and treatment, chronic pain remains an unsolved and all too common problem. One of the main obstacles to successful management of pain is the high variability of many patients regarding both response to treatment and susceptibility to adverse effects, which curtails the utility of therapeutic intervention. Understanding the causes of this variability is an important challenge which may lead to a new era in rational pain management. ⋯ Rational personalized pain management must take into consideration both ever-increasing knowledge of pharmacogenetics and pharmacokinetics and a broad, clinically based attitude incorporating co-morbidities, both physical and psychiatric, and concomitant medications. Novel models for testing in-vivo pain processing, for example assessment of conditioned pain modulation (CPM), are also promising approaches to use of rational data for empirical treatment of pain. Last, listening to the patient and understanding the context in which pain has affected his or her life is an important part of maintaining the personal nature of therapeutic interaction with patients suffering from pain.
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Review Meta Analysis
A meta-analytic review of the hypoalgesic effects of exercise.
The purpose of this article was to examine the effects of acute exercise on pain perception in healthy adults and adults with chronic pain using meta-analytic techniques. Specifically, studies using a repeated measures design to examine the effect of acute isometric, aerobic, or dynamic resistance exercise on pain threshold and pain intensity measures were included in this meta-analysis. The results suggest that all 3 types of exercise reduce perception of experimentally induced pain in healthy participants, with effects ranging from small to large depending on pain induction method and exercise protocol. In healthy participants, the mean effect size for aerobic exercise was moderate (d(thr) = .41, d(int) = .59), while the mean effect sizes for isometric exercise (d(thr) = 1.02, d(int) = .72) and dynamic resistance exercise (d(thr) = .83, d(int) = .75) were large. In chronic pain populations, the magnitude and direction of the effect sizes were highly variable for aerobic and isometric exercise and appeared to depend on the chronic pain condition being studied as well as the intensity of the exercise. While trends could be identified, the optimal dose of exercise that is needed to produce hypoalgesia could not be systematically determined with the amount of data available. ⋯ This article presents a quantitative review of the exercise-induced hypoalgesia literature. This review raises several important questions that need to be addressed while also demonstrating that acute exercise has a hypoalgesic effect on experimentally induced pain in healthy adults, and both a hypoalgesic and hyperalgesic effect in adults with chronic pain.
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Workplace health & safety · Dec 2012
ReviewPain management in occupational health: a guide for non-narcotic pain relief.
Narcotic pain management is currently a topic of concern in the United States; the latest concerns are both legal and ethical. Narcotics are frequently prescribed medications that, when improperly used or supervised, can cause death. ⋯ Injured workers need to have pain controlled and be mentally safe to perform their job duties. This article identifies types of pain, comorbidities, and alternative methods of pain management beyond narcotic therapy, as well as discusses guidelines used to initiate narcotic therapy when needed.
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When a patient who's physically active complains of hip pain, don't be too quick to label it a "hip pointer" that requires time and rest to heal. Consider this more nuanced-and effective-approach.