Don't Withhold Opioid Pain Therapy From Recovering Addicts

2006 ◽  
Vol 39 (11) ◽  
pp. 47
Author(s):  
BRUCE K. DIXON
Keyword(s):  
Pain Therapy ◽  
Recovering Addicts

Schmerztherapie nach thoraxchirurgischen Eingriffen

2018 ◽  
Vol 12 (02) ◽  
pp. 155-165
Author(s):  
Holger Hendrix ◽  
Vladimir Kamlak ◽  
Georgi Prisadov ◽  
Katrin Welcker
Keyword(s):  
Thoracic Surgery ◽  
Pain Therapy ◽  
Pain Treatment ◽  
Internal Standards ◽  
Pain Experience ◽  
Thoracic Surgical Procedures ◽  
Therapeutic Algorithm ◽  
Alternative Procedures ◽  
The Individual ◽  
Documentation Form

The treatment of pain after thoracic surgery is a challenge and takes place in the individual clinics mostly according to clinic internal standards. It exists no currently valid S3 guideline for the treatment of acute perioperative and posttraumatic pain. For an effective pain treatment as well individual pain experience as the pain intensity of the various thoracic surgical procedures must be considered. Regular pain assessment with appropriate methods and their documentation form the basis for adequate and adapted pain therapy.There are a number of different pain therapy methods, non-medicamentous and drug-based methods, whose effectiveness is described in the literature partially different. For the treatment of acute postoperative pain after thoracic surgery, mainly drug-related procedures are used, except for physiotherapy as a non-medicamentous method. Increasingly, alternative procedures for the peridural catheter as a therapeutic gold standard in the treatment of pain after thoracic surgery are used. Their application can be integrated into a therapeutic algorithm.

Design and Evaluation of a Modulated TENS Stimulation in Medical Pain Therapy

2019 ◽  
Vol 14 (1) ◽  
pp. 75-83
Author(s):  
L. Bouafif ◽  
N. Ellouze
Keyword(s):  
Pain Intensity ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Pain Therapy ◽  
Subjective Evaluation ◽  
Large Population ◽  
Electrical Current ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Electrical Nerve Stimulation

Background: Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive pain therapy that uses the sensory effects of an electrical current applied to the skin. Some clinical studies demonstrated that this treatment helps to reduce acute and chronic pains, while others gave sometimes contradictory or uncertain conclusions about the performances of this strategy according to pathology classification. The purpose of this study is the development and evaluation of a new modulated version of transcutaneous electrical nerve stimulation called PWM-TENS. The principle is based on an automatic variation of the stimulation parameters (frequency, amplitude, duration, shape, cyclic ratio) according to the pain evolution. Methods: The study was a controlled clinical trial involving 15 participants, divided into 2 groups. The first experimental group performed modulated PWM-TENS electro-stimulation sessions applied to the painful areas 3 to 4 times a day, for one month. The second control group did parallel treatments by Placebo. The evaluation of the pain intensity is done with the Visual Analog Scale (EVA), the DN4 and SF36 questionnaires. Results: The tests and measurements with our embedded PWM-TENS technique demonstrated that we succeeded to increase the analgesic effect after stopping the stimulation and reduced the pain sensation by about 60%. An improvement in pain intensity scores and questionnaires (EVA, DN4), as well as the quality of life score (SF36), was observed. Also, a reduction of the treatment period from 3 to 1 month was also obtained. Conclusion: The first results clinically observed in the PWM-TENS technique are encouraging. The findings of this study confirm that this noninvasive strategy is suitable and useful for acute pains coming from the nociceptive, neuropathic and musculoskeletal origin. However, its efficiency is moderated and less adapted for low back pain. The experiments make it possible to estimate whether this modulated TENS method could improve existing anti-pain therapies, taking into account objective and subjective evaluation criteria. But this study must be followed by large population samples to answer all the problems of acute and chronic pains.

Pain-Prescription Differences - An Analysis of 500,000 Discharge Summaries

2019 ◽  
Vol 11 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Saskia Preissner ◽  
Vishal B. Siramshetty ◽  
Mathias Dunkel ◽  
Paul Steinborn ◽  
Friedrich C. Luft ◽  
...  
Keyword(s):  
Pain Therapy ◽  
Opioid Analgesic ◽  
Developed Countries ◽  
Discharge Summary ◽  
Pain Reliever ◽  
Regulatory Guidelines ◽  
The Usa ◽  
Prescription Rates ◽  
East West ◽  
Discharge Summaries

Background: Pain-relief prescriptions have led to an alarming increase in drug-related abuse. Objective: In this study, we estimate the pain reliever prescription rates at a major German academic hospital center and compare with the nationwide trends from Germany and prescription reports from the USA. Methods: We analysed >500,000 discharge summaries from Charité, encompassing the years 2006 to 2015, and extracted the medications and diagnoses from each discharge summary. Prescription reports from the USA and Germany were collected and compared with the trends at Charité to identify the frequently prescribed pain relievers and their world-wide utilization trends. The average costs of pain therapy were also calculated and compared between the three regions. Results: Metamizole (dipyrone), a non-opioid analgesic, was the most commonly prescribed pain reliever at Charité (59%) and in Germany (23%) while oxycodone (29%), a semi-synthetic opioid, was most commonly ordered in the USA. Surprisingly, metamizole was prescribed to nearly 20% of all patients at Charité, a drug that has been banned for safety reasons (agranulocytosis) in most developed countries including Canada, United Kingdom, and USA. A large number of prospective cases with high risk for agranulocytosis and other side effects were found. The average cost of pain therapy greatly varied between the USA (125.3 EUR) and Charité (17.2 EUR). Conclusion: The choice of pain relievers varies regionally and is often in disagreement with approved indications and regulatory guidelines. A pronounced East-West gradient was observed with metamizole use and the opposite with prescription opioids.

scholarly journals AB0267 HOW EFFECTIVE IS PAIN MANAGEMENT IN THE PATIENTS’ OPINION? DATA FROM THE COMPAS STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1160.1-1160
Author(s):  
E. Pogozheva ◽  
A. Karateev ◽  
V. Amirdzhanova
Keyword(s):  
Pain Management ◽  
Pain Therapy ◽  
Significant Proportion ◽  
Connective Tissue Diseases ◽  
Underlying Disease ◽  
Additional Treatment ◽  
Results Of Treatment ◽  
Analgesic Therapy ◽  
Folk Remedies ◽  
Personalized Approach

Objectives:to evaluate the effectiveness and satisfaction of pain management in patients with rheumatic diseases (RD) according to a survey in the COMPAS (Quality of Pain Management according to Patients with Arthritis and Back pain) study.Methods:the survey involved 1040 patients with RD (rheumatoid arthritis-40.6%, osteoarthritis -32.1%, spondyloarthritis-10.6%, connective tissue diseases-8.6% of patients). 76.8% were women, the mean age was 55.8±14.0 years. 35.7% of patients continued to work in their specialty, 31.6% had various degrees of disability. The effectiveness of pain therapy was evaluated by the patient in the last month preceding the survey on a 5-point scale, where 1 - no effect and 5-excellent effect. Patients ‘ satisfaction with treatment, possible reasons for the lack of effectiveness of pain therapy and the use of additional treatment tools were also evaluated.Results:as therapy for the underlying disease, 40% of patients received conventional disease modifying antirheumatic drugs, 33.1% - glucocorticoids, 7.2% - biological agents and 15.2% - symptomatic slow-acting drugs in osteoarthritis. At the same time, 68% of patients needed additional analgesic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Slightly less than half of the surveyed patients (46.9%) noted a moderate effect of analgesic therapy, 22.7% - a low effect and 5% - no effect, 23.7% rated the effectiveness of therapy as good and only 1.7% - as excellent. At the same time, only 15.6% of patients were completely satisfied with the result of NSAIDs, 64% were partially satisfied with the treatment and 20.4% were completely dissatisfied. As the reason of insufficient effectiveness of NSAIDs, most often (34.3%) patients named fear of adverse events associated with taking drugs, 19.4% - weak drugs, 15.3% - insufficient attention of doctors to complaints, 6.6% - poor diagnosis of the causes of pain. Others found it difficult to answer or were completely satisfied with the treatment. 40% of patients used additional methods, most often chiropractic (12.3%), acupuncture (4.8%), physiotherapy (12.7%) and folk remedies (7.4%).Conclusion:A significant proportion of patients with RD don’t have adequate pain control. Only 25.4% of patients rate the result of treatment as good and excellent, and even fewer patients (15.6%) are completely satisfied with the results of therapy. Thus, a personalized approach to analgesic therapy is necessary, taking into account the expectations of patients regarding the results of treatment.Disclosure of Interests:None declared

scholarly journals Golden plaster for pain therapy in patients with knee osteoarthritis: study protocol for a multicenter randomized, double-blind, placebo-controlled trial

Trials ◽  
2013 ◽  
Vol 14 (1) ◽  
pp. 383 ◽  
Author(s):  
Jin-Tao Liu ◽  
De-Zhi Tang ◽  
Xiao-Feng Li ◽  
Zhi-Gang Zhang ◽  
Wan-Bo Ji ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Study Protocol ◽  
Pain Therapy ◽  
Controlled Trial ◽  
Double Blind ◽  
Double Blind Placebo

scholarly journals Intensive Care in a Patient with Toxic Epidermal Necrolysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
J. Wallenborn ◽  
M. Fischer
Keyword(s):  
Adverse Drug Reaction ◽  
Medical Care ◽  
Toxic Epidermal Necrolysis ◽  
Marked Improvement ◽  
Pain Therapy ◽  
The Body ◽  
Rapid Progression ◽  
Volume Management ◽  
Multiresistant Bacteria ◽  
Mucosal Involvement

Toxic epidermal necrolysis (TEN) is a serious adverse drug reaction with high lethality, which usually requires intensive-medical care. A 44-year-old man developed generalized exanthema with increasing exfoliation and mucosal involvement after taking allopurinol, ibuprofen, and etoricoxib. The clinical diagnosis of TEN was histologically confirmed. Prednisolone therapy with 3 mg/kg body weight (BW) was not able to prevent further progress to finally 80% of the body surface, and infliximab 5 mg/kg BW was given as a single dose. This prevented further progression of the TEN. Despite marked improvement in skin findings, the ICU stay was prolonged by a complex analgosedation, transient kidney failure, volume management, positioning therapy, and vegetatively impeded weaning. Moreover, there was colonization with multiresistant bacteria (MRSA and VRE). Nonetheless, the patient could be restored to health and was released after four weeks. Infliximab seems to be effective in the treatment of TEN, especially in cases of rapid progression. Moreover, patients with TEN are difficult to handle in intensive-medical care, whereby attention should especially be paid to sufficient pain therapy, and the positioning of the patient is a particular challenge.

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