Articles: pain-management-methods.
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Parkinsonism Relat. Disord. · Dec 2012
ReviewThe conceptual framework of palliative care applied to advanced Parkinson's disease.
With the incidence of Parkinson's disease rising, while imposing a large cost on health care systems around the world, optimizing care has become crucial. The complexity of our patients increases dramatically in the advanced stages. Recently our understanding of advanced Parkinson's disease has led to the question of whether Palliative care approaches would be complementary to the care of these patients. ⋯ Pain has become recognized as a common symptom that can be difficult to treat. Given the success of early Palliative care involvement in cancer populations, it should not be surprising that our specialized Palliative Parkinson's Clinic at the Toronto Western Hospital has become indispensable for our patients. This article will describe the rational for combining the expertise of the Neurology department with that of Palliative care in the care of patients suffering from Parkinson's disease.
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Analgesia and coping with labor pain can prevent suffering during childbirth. Nonpharmacologic methods help women manage labor pain. Strong evidence is available for the efficacy of continuous one-to-one support from a woman trained to provide nonmedical care during labor, immersion in warm water during first-stage labor, and sterile water injected intracutaneously or subcutaneously at locations near a woman's lumbosacral spine to reduce back-labor pain. ⋯ Although observational studies have found associations between maternal use of opioids and neonatal complications, little higher level evidence is available except that meperidine is associated with low Apgar scores. Patient-controlled intravenous administration of remifentanil provides better analgesia and satisfaction than other opioids, but can cause severe side effects; continuous monitoring of arterial oxygen saturation, anesthesia supervision, one-to-one nursing, and availability of oxygen are recommended. The demand for inexpensive, simple, safe but effective labor pain management for women will undoubtedly increase in places that lack wide access to it now.
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Review Comparative Study
Distraction techniques for children undergoing procedures: a critical review of pediatric research.
Pediatric patients are often subjected to procedures that can cause pain and anxiety. Although pharmacologic interventions can be used, distraction is a simple and effective technique that directs children's attention away from noxious stimuli. ⋯ Given the range of distraction techniques, the purpose of this article was to provide a critical assessment of the evidence-based literature that can inform clinical practice and future research. Recommendations include greater attention to child preferences and temperament as a means of optimizing outcomes and heightening awareness around child participation in health care decision making.
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Curr Opin Anaesthesiol · Dec 2012
ReviewRecovery after orthopedic surgery: techniques to increase duration of pain control.
Ambulatory surgery continues to expand in scope and volume. Part of this development is supported by improvements in anesthesia care, especially in the realm of postoperative analgesia, which is often outlasted by the pain. The purpose of this review is to outline methods of increasing the duration of postoperative pain control. ⋯ The ideas and findings described in this review are taken from the most recent literature and show promise of aiding in the continued improvement of patient care through their dissemination and refinement by further research. Of the modalities reviewed in current use, the continuous perineural catheter combined with systemic multimodal analgesics represents the best combination of safety and efficacy to provide prolonged postoperative analgesia.