Articles: pain-management-methods.
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Anesthesiology clinics · Dec 2011
Sedation and weaning from mechanical ventilation: linking spontaneous awakening trials and spontaneous breathing trials to improve patient outcomes.
The use of sedation has long been integrated into critical care. Because pain, discomfort, anxiety, and agitation are commonly experienced by critically ill patients, the use of medications to alleviate and control these symptoms will continue; however, data showing that prolonged use of sedating medications imparts harm to patients obligate physicians to use agents and methods of sedation that minimize these negative side effects. ⋯ Regardless of choice of sedating agent, and even when patient-targeted sedation protocols are used to minimize oversedation, the use of spontaneous awakening trials dramatically improves patient outcomes for critically ill patients. Intensive care physicians must continue to study the delivery of sedation in efforts to maximize patient comfort while minimizing patient harm.
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The study was set in an Australian tertiary public hospital multidisciplinary pain center. ⋯ Changes to conceptual framework inevitably influence the practicalities of service delivery. The application of a whole-person model for persistent pain brought improved engagement with the individual in pain and more efficient delivery of care at a systems level.
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Nursing & health sciences · Dec 2011
Attitudes, beliefs, and practices of Sri Lankan nurses toward cancer pain management: an ethnographic study.
Cancer pain is a serious problem that requires specialized nursing knowledge. In the present ethnographic study, we sought to explore the experiences and cancer pain management practices of nurses working at a government hospital in Sri Lanka. Data were collected from October 2007 to January 2008, and were obtained by observing the nurses in a cancer ward, conducting semistructured interviews with 10 participants, and maintaining a research diary. ⋯ Additionally, the nurses are not autonomous, and are required to refer to medical staff for cancer pain management strategies. The nurses work in a task-oriented system that rarely acknowledges cancer patients' pain management needs. This study might improve nursing pain management practices for cancer patients and lead to changes in the curriculum of nursing courses in Sri Lanka.
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The evolution of interventional pain management from inception through the present is examined. Increasing demand from patients, referring physicians and third party payors for proven interventions which provide long-term functional relief of symptoms or primary correction of common spinal pain syndromes is discussed. ⋯ Practitioners are encouraged to transition from the use of spinal injections and narcotics of unproven benefit to percutaneous and endoscopic spinal intervention as primary therapy of herniated lumbar disc, discogenic spinal pain, and lumbar spinal stenosis in appropriately selected patients. SD, Expenditures and health status among adults with back and neck problems.
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Postoperative nausea and vomiting (PONV) and pain are two of the major concerns for patients presenting for surgery. The causes of PONV are multifactorial and can largely be categorized as patient risk factors, anaesthetic technique, and surgical procedure. Antiemetics work on several different receptor sites to prevent or treat PONV. ⋯ With the increasing understanding of the pathophysiology of acute pain, especially the occurrence of peripheral and central hypersensitization, it is unlikely that a single drug or intervention is sufficiently broad in its action to be adequately effective, especially with moderate or greater pain. Although morphine and its congeners are usually the foundation of pain management regimens, as their dose increases so does the incidence of side-effects. Thus, the approach for the management of acute postoperative pain is to use multiple drugs or modalities (e.g. regional anaesthesia) to maximize pain relief and reduce side-effects.