Articles: pain-management.
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Journal of anesthesia · Sep 1994
Assessment of postoperative pain: Contributing factors to the differences between patients and doctors.
This study was undertaken to compare the assessment of pain intensity by 50 patients and by their doctors according to a visual analog scale 5 h and 20 h after major abdominal surgery, and to examine the relationships between the differences in rating of patients and doctors and the factors inherent in the patients which include preoperative expectation of pain, level of anxiety, and the surgical history of the patient. The ratings given by the patients were significantly higher than those given by the doctors at both time periods. ⋯ The results of analysis using Hayashi's quantification theory Type II indicated a moderate association between the rating difference and the patient's age, surgical history, preoperative state of anxiety, and expectation of pain. It is concluded that postoperative pain management, whether in clinical practice or in research, necessitates more consideration of the several above-mentioned individual factors and a preoperative interview in which the patient's level of anxiety and the amount of information the patient has concerning the surgery and post-operative pain is clearly assessed.
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Surveys indicate that clinicians are frequently ill equipped to treat cancer pain. Pain is often poorly assessed, and many caregivers lack sufficient knowledge to optimize treatment. Effective management requires an understanding of pain pathophysiology, the ability to identify and evaluate pain syndromes, and familiarity with proven therapeutic strategies. ⋯ Sedation is an option at the end of life for the treatment of pain that is refractory to other interventions. These approaches can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative medicine.
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Despite its use for a long time, the way thalamic ventrobasal (VB) stimulation acts to produce pain relief is still unknown. One of the most accepted hypotheses, sponsored by Tsubokawa among others, proposes that VB stimulation excites raphespinal and reticulospinal neurons of the rostroventral medulla which in turn send respectively inhibitory serotonergic and noradrenergic axons through both dorsolateral funiculi (DLF) to the dorsal horn (DHA) nociceptive neurons; this pathway would be the same as is involved in periventricular-periaqueductal gray (PVG-PAG) stimulation induced inhibition of DH nociceptive neurons. This hypothesis implicates the necessity of DLF intactness; in fact, it was showed that section of bilateral DLF inhibits the response of DH nociceptive neurons to VB stimulation. ⋯ In order to check these possibilities, the patients with central cord-based pain admitted to the Division of Neurosurgery, Toronto Hospital between June 1978 and July 1991 to undergo deep brain stimulation (DBS) were reviewed. Sixteen patients were operated on. Based on clinical criteria, four out of these sixteen patients were thought to present complete cord transection (all four were men, with an average age of 48 years and pain secondary to cord injury).(ABSTRACT TRUNCATED AT 250 WORDS)
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State of the art techniques for perioperative pain management in orthopaedic surgery have evolved from cumulative advances in basic sciences, technology, psychology, and changes in physician and nursing practices. Each advance in the understanding of pain physiology and pharmacology and the pain experience has suggested more effective strategies for intervention. ⋯ Coincident with an increase in demand for these services has been the evolution of interdisciplinary pain management teams commonly known as the Acute Pain Treatment Service. In the context of the national debate on health care reform, research priorities in the field include documentation of impacts on patient outcomes, and influences on the cost of health care.
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A survey of the analgesia regimens used in burns units throughout the UK was performed. Continuous intravenous opiate infusions remain the mainstay for providing pain relief in patients in severe pain as a result of burn injuries. Other methods include: patient-controlled analgesia in appropriate patients, bolus doses of opiates combined with Entonox for control of peaks of pain and a wide variety of oral analgesics for less painful burn injuries.