Articles: pain-management-methods.
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Randomized Controlled Trial
Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial.
Attentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition. It has been hypothesized that this may be due to the non-engaging types of distraction that have been used so far. Moreover, it is suggested that the hypoalgesic effects of distraction may be attenuated by pain-related cognitions and emotions, as they may increase the attention to pain. ⋯ Large effect sizes of VR distraction induced hypoalgesia were observed. This suggests that nonimmersive VR games can be used when it is deemed important to reduce the pain during exercises in patients with chronic nonspecific low back pain.
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Fasciotomy is a life-saving procedure to treat acute compartment syndrome, a surgical emergency. As fasciotomy dramatically improves wound pain, it should be performed as soon as possible. Moreover, delays in the use of fasciotomy can increase the rate of wound infections. Once the fasciotomy wound is infected, pain control is achieved via the long-term use of opioids or anti-inflammatory analgesics. However, the administration of high doses of opioids may cause complications, such as respiratory depression, over-sedation, and constipation. Therefore, treatment methods other than narcotic administration should be established to better manage the pain caused by fasciotomy wound infections. Virtual reality has recently been introduced in analgesic therapy as a replacement, or complement, to conventional pharmacological treatments. Its use has been extensively studied in the pain management of patients with burns. An increasing number of painful conditions are being successfully treated with virtual reality. Here, we report a case of acute compartment syndrome complicated by fasciotomy wound infection. ⋯ This case suggests the feasibility of virtual reality analgesic therapy for pain management of fasciotomy wound complications in acute compartment syndromes. Virtual reality represents a treatment option that would reduce analgesic consumption and eliminate opioid-induced respiratory depression to treat fasciotomy wound infection.
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Curr Pain Headache Rep · Apr 2020
ReviewDexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain.
Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU). ⋯ Dexmedetomidine, a selective alpha2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.
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The use of hypnosis to promote hypnoanalgesia has a long history and has been written about anecdotally as well as having been researched in the last several decades. Research has been both clinical in nature and, in the laboratory, trying to understand the brain physiology and processes involved. This article is not about a review of the research. ⋯ Due to the restraints of limited space, I can only discuss the various techniques briefly. I will describe a philosophical perspective that has served me well and driven my approach to treatment. I will discuss the concept of self-regulation training along the dimensions of Sensation, Affect, Cognition, and Behavior and share how hypnosis has been incorporated in working within each of those aspects of experiencing.
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Review Meta Analysis
Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis.
Although music interventions on postoperative pain (POP) have positive effects, limited research has focused on systematic reviews and meta-analyses of its efficacy for orthopedic patients. This systematic review aimed to examine the effects of music therapy on pain after orthopedic surgery. ⋯ Music can significantly relieve POP, specifically music chosen by the participants.