Articles: pain-management-methods.
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Eur J Cardiovasc Nurs · Mar 2012
Controlled Clinical TrialPain management after cardiac surgery: experience with a nurse-driven pain protocol.
Management of post-operative pain is important for decreasing post-operative morbidity and mortality. After evaluating our pain score database of patients undergoing cardiac surgery (2007-2009) we revised our pain protocol. The new protocol allows nurses to administer analgesic medication without consulting the attending physician. The setting was a medium care unit, a nursing ward with additional monitoring of heart rate and rhythm. We investigated the effects of this revised pain protocol in a prospective consecutive cohort study. ⋯ This study shows that in post-cardiac surgery patients a significant reduction in VAS scores can be safely realized by a nurse-driven protocol. Furthermore, a reduction in time to achieve an acceptable pain score (VAS < 4) was realized.
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To describe the results of a Numeric Rating Scale (NRS)-guided pharmacological pain management strategy in symptomatic knee and hip osteoarthritis (OA) in daily clinical practice. ⋯ Adequate use of paracetamol and switching to a NSAID after failing paracetamol resulted in moderate treatment response percentages, whereas the result of a second NSAID was disappointing in patients with advanced knee and hip OA. Predictors for response included patient and disease related factors. A substantial part of patients with NRS >4 were unwilling to change their analgesics.
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Paediatric anaesthesia · Mar 2012
Perioperative opiate requirements in children with previous opiate infusion.
Critically ill children often require continuous opiate infusions. Tolerance may develop requiring a weaning strategy to prevent withdrawal symptoms. These children may also require subsequent surgical procedures. This is the first study to investigate whether previously opiate-tolerant patients require higher doses of opiates for adequate pain management perioperatively. ⋯ The perioperative opiate requirements of pediatric patients who were successfully weaned after prolonged opiate use were similar to opiate-naïve patients. A history of prolonged opiate use alone does not necessitate special pain management for future procedures.
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Adenosine 5'-triphosphate disodium (ATP) gated P2X receptors, especially the subtype P2X(3), play a key role in transmission of pain signals in neuropathic pain, ATP has been documented to play a significant role in the progression of pain signals, suggesting that control of these pathways through electroacupuncture (EA) is potentially an effective treatment for chronic neuropathic pain. EA has been accepted to effectively manage chronic pain by applying the stimulating current to acupoints through acupuncture needles. To determine the significance of EA on neuropathic pain mediated by P2X(3) receptors in the dorsal root ganglion (DRG) neurons, mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were recorded, and the expression of P2X(3) receptors in the DRG neurons was assessed by immunohistochemistry (IHC) and in situ hybridization (ISH). ⋯ Simultaneously, EA treatment attenuates the ATP and α,β-meATP evoked currents. EA may be expected to induce an apparent induce analgesic effect by decreasing expression and inhibiting P2X(3) receptors in DRG neurons of CCI rats. There is a similar effect on analgesic effect between rats with contralateral EA and those with ipsilateral EA.