Articles: pain-measurement.
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The American Geriatrics Society has recently published clinical practice guidelines addressing chronic pain in older adults. The guidelines identify current provider-based and system-oriented barriers and recommend practice improvements to enhance routine assessment, pharmacological therapy, and nonpharmacological therapy. Recommended organizational improvements focus on facilitating access and delivery of optimal care for all older adults living with chronic pain. Nurses are encouraged to assess older adults routinely for the presence of chronic pain and to advocate for appropriate treatment when indicated.
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This article reviews the evaluation of pain in critically ill patients of all ages. Sources of pain and its physiologic significance are discussed. ⋯ The evaluation process, including a discussion of several tools ranging from visual analog scales to bispectral analysis, as well as goals of therapy are discussed. Finally, a practical approach to the assessment process, which supports the need for established, regularly used evaluation and treatment protocols, is proposed.
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Postherpetic neuralgia (PHN) is a neuropathic pain disorder that occurs most often in the elderly. This painful condition is uniquely suited for clinical research, resulting in an emerging understanding of the pathophysiology of the persistent pain. Until recently, only the tricyclic antidepressants proved effective for PHN. Controlled trials of a wide variety of therapeutic strategies are in progress or have been recently completed.
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Pain assessment and physical examination are the first crucial steps in diagnosis of neuropathic pain disorders because these are still solely diagnosed on clinical grounds. The physical examination should be conducted in such a way that all of the positive sensory phenomena, such as allodynia, hyperalgesia, hyperpathia, summation, and after-sensation are elicited. Other physical examination findings should corroborate the diagnostic impression of neuropathic pain. Specific pain diagnosis should then lead to more specific therapy.
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This article critically reviews the measures developed for assessing pain in the human neonate. Information was gathered with a computerized literature search of published articles and abstracts, a manual review of relevant conference proceedings, recently published journals, unpublished reports and manuscripts, and personal files. This identified 16 measures that were critically examined for their psychometric properties (reliability and validity) and clinical use. ⋯ A sufficient number of infant pain measures have now been developed to assess acute pain. There is a paucity of measures to assess chronic pain in infants, and measures for infants who are low birth weight, critically ill, or ventilated. Future research should be aimed at strengthening the properties of existing measures, and at the development of measures for those infants with chronic pain or special needs.