Articles: pain-management-methods.
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Comparative Study
A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study.
Cancer recurrence after surgery may be affected by immunosuppressive factors such as surgical stress, anesthetic drugs, and opioids. By limiting exposure to these, epidural analgesia may enhance tumor surveillance. This study compared survival and cancer recurrence rates for resection of colorectal cancer between patients who received perioperative epidurals and those who did not. ⋯ This large cohort study found that epidural use is associated with improved survival in patients with nonmetastatic colorectal cancer undergoing resection but does not support an association between epidural use and decreased cancer recurrence.
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Randomized Controlled Trial
Distracting children during blood draw: looking through distraction cards is effective in pain relief of children during blood draw.
This study aims to investigate the effects of distraction method by way of looking through distraction cards/Flippits® to reduce procedural pain and anxiety during blood draw. In this method we distract attention of the children with distraction cards/Flippits®. Flippits® consist of various eye-catching pictures and shapes. ⋯ Results show that pre-procedural anxiety did not differ significantly. However, the experimental group had significantly lower pain levels than the control group during the blood draw procedure. Also experimental group had significantly lower anxiety levels than the control group.
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We tested home pain management for children for effects on pain intensity, analgesics administered, satisfaction, and use of healthcare services over 3 post-discharge days. ⋯ Further research is needed to develop and test effective education interventions to facilitate relief of children's postoperative pain.
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Perceived control over pain can attenuate pain perception by mechanisms of endogenous pain control and emotional reappraisal irrespective of whether this control is exerted or only perceived. Self-initiated termination of pain elicits different expectations of subsequent pain relief as compared to perceived pain control. It is unknown whether and how this perceived vs. exerted control on pain differs and affects subsequent pain relief. ⋯ Using controllability as factor, there was dissociable neural activity during pain relief: following the perceived control condition neural activity was found in the orbitofrontal and mediofrontal cortex and, following the exerted control condition, in the anterolateral and dorsolateral prefrontal cortex and posterior parietal cortex. We conclude that (i) pain controllability has an impact on pain relief and (ii) the prefrontal cortex shows dissociable neural activity during pain relief following exerted vs. perceived pain control. This might reflect the higher grade of uncertainty during pain relief following perceived pain control mediated by the orbitofrontal and medial prefrontal cortex and processes of working memory and updating expectations during pain relief following exerted control mediated by the lateral prefrontal cortex.
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Comparative Study
Using process analysis to assess the impact of medical education on the delivery of pain services: a natural experiment.
The medical, social, and economic effects of the teaching mission on delivery of care at an academic medical center (AMC) are not fully understood. When a free-standing private practice ambulatory clinic with no teaching mission was merged into an AMC, a natural experiment was created. The authors compared process measures across the two settings to observe the differences in system performance introduced by the added steps and resources of the AMC's teaching mission. ⋯ Although the teaching mission of the AMC adds processing steps and costs, the use of trainees within the process serves to increase throughput while decreasing waiting times and the use of overtime.