Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people

The authors review the neural pathways mediating nociceptive flexion reflexes, the method for analyzing these reflexes in human beings, and available data on their modulation by supraspinal, opioid as well as serotonergic systems. They present results of studies of the biceps femoris flexion reflex (RIII) in pain syndromes and various types of headache. Nociceptive flexor reflexes appear to be interesting for studying the pathophysiology of head pain mechanisms and possibly for evaluating analgesic treatment.

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Chronic disease and elderly care

Oxford Handbook of General Practice ◽

10.1093/med/9780198808183.003.0008 ◽

2020 ◽

pp. 171-202

Author(s):

Chantal Simon ◽

Hazel Everitt ◽

Françoise van Dorp ◽

Nazia Hussain ◽

Emma Nash ◽

...

Keyword(s):

General Practice ◽

Chronic Disease ◽

Older People ◽

Pain Control ◽

Elderly Care ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Normal Ageing ◽

Unexplained Symptoms ◽

Strong Opioids

This chapter in the Oxford Handbook of General Practice explores chronic disease and elderly care in general practice. It examines chronic disease management, multimorbidity, genetics and genomics, and medically unexplained symptoms (MUS). It covers the assessment of pain and neuropathic pain, as well as the principles of pain control and pain-relieving drugs including morphine and other strong opioids. It also reviews all aspects of normal ageing, including falls in older people, prescribing for older people, elderly care and disability management, maintaining independence, and carers.

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Patient and physician satisfaction with analgesic treatment in Southeast Asia (SEA): Findings from the analgesic treatment for cancer pain in Southeast Asia (ACE) study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21698 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21698-e21698

Author(s):

Hanlim Moon ◽

Dang Huy Quoc Thinh ◽

Wimonrat Sriraj ◽

Marzida Binti Mansor ◽

Kian Hian Tan ◽

...

Keyword(s):

Southeast Asia ◽

Cancer Pain ◽

Sleep Disturbance ◽

Pain Intensity ◽

Pain Control ◽

Oral Morphine ◽

Physician Satisfaction ◽

Analgesic Treatment ◽

Ace Study ◽

Pain Status

e21698 Background: Adequate dosing of analgesics is important for optimum cancer pain control & quality of life (QoL). To understand current attitudes toward analgesic treatment for cancer pain in SEA, the ACE study explored patient & physician satisfaction with pain control in 6 SEA countries. Methods: This cross-sectional observational study included 465 adult outpatients prescribed analgesics for cancer pain for ≥1 month in Indonesia, Malaysia, Philippines, Singapore, Thailand, & Vietnam. Pain intensity, sleep disturbance, QoL, satisfaction with pain control, & physicians’ assessment of adequacy of analgesics were recorded via questionnaires. Current analgesic doses prescribed were extracted from medical records. Results: Most patients (84%) had stage 3 or 4 cancer. While 91% were prescribed opioids, mean reported pain intensity was 4.1 (0/no pain, 10/worst possible pain) & most had problems with sleep (55%) & QoL (problems with pain/discomfort [82%], usual activities [66%] & anxiety/depression [56%]). 60% of patients were satisfied with their pain control status & 30% found it acceptable. Physicians more often reported dissatisfaction with patients’ pain control status compared with patients (21% vs 10%). Patient-physician concordance in satisfaction with pain control was low (weighted Kappa 0.36; 95% CI 0.30-0.43). More than 1 in 4 physicians (29%) assessed prescribed analgesics to be “inadequate” for pain control. Median daily dose prescribed in oral morphine equivalents was 30 mg for both morphine & tramadol. Of the SEA countries included, prescribed doses of opioids were generally lower in Indonesia & higher in Vietnam. Conclusions: The results highlight the complexity of managing cancer pain in SEA. Despite unrelieved pain, sleep disturbance & QoL issues, many patients still reported satisfaction with pain control. Notably, physicians expressed dissatisfaction more frequently than patients. These findings suggest a need for all-round pain status assessment (including pain intensity, sleep disturbance, QoL) & improved patient-physician communication about analgesic treatment expectations, pain control & adverse effects.

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Patient and Physician Satisfaction with Analgesic Treatment: Findings from the Analgesic Treatment for Cancer Pain in Southeast Asia (ACE) Study

Pain Research and Management ◽

10.1155/2018/2193710 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Dang Huy Quoc Thinh ◽

Wimonrat Sriraj ◽

Marzida Mansor ◽

Kian Hian Tan ◽

Cosphiadi Irawan ◽

...

Keyword(s):

Cancer Pain ◽

Pain Intensity ◽

Pain Control ◽

Weighted Kappa ◽

Physician Satisfaction ◽

Cross Sectional ◽

Analgesic Treatment ◽

Ace Study ◽

Pain Patients

Aim. The aim of this study was to examine patients’ and physicians’ satisfaction, and concordance of patient-physician satisfaction with patients’ pain control status. Methods. This cross-sectional observational study involved 465 adults prescribed analgesics for cancer-related pain from 22 sites across Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam. Pain intensity, pain control satisfaction, and adequacy of analgesics for pain control were documented using questionnaires. Results. Most patients (84.4%) had stage III or IV cancer. On a scale of 0 (no pain) to 10 (worse pain), patients’ mean worst pain intensity over 24 hours was 4.76 (SD 2.47). More physicians (19.0%) than patients (8.0%) reported dissatisfaction with patient’s pain control. Concordance of patient-physician satisfaction was low (weighted kappa 0.36; 95% CI 0.03–0.24). Most physicians (71.2%) found analgesics to be adequate for pain control. Patients’ and physicians’ satisfaction with pain control and physician-assessed analgesic adequacy were significantly different across countries (P<0.001 for all). Conclusions. Despite pain-related problems with sleep and quality of life, patients were generally satisfied with their pain control status. Interestingly, physicians were more likely to be dissatisfied with patients’ pain control. Enhanced patient-physician communication, physicians’ proactivity in managing opioid-induced adverse effects, and accessibility of analgesics have been identified to be crucial for successful cancer pain management. This study was registered at ClinicalTrials.gov (identifier NCT02664987).

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Ileal impaction resolution in a horse with colic via a standing right flank laparotomy ˗ case report

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/1678-4162-11749 ◽

2020 ◽

Vol 72 (4) ◽

pp. 1369-1374

Author(s):

J.A. Arantes ◽

G.M. Reginato ◽

R.G.S. Dória

Keyword(s):

Case Report ◽

Surgical Procedures ◽

Pain Control ◽

Standing Position ◽

Fast Recovery ◽

Viable Option ◽

Financial Problems ◽

Analgesic Treatment ◽

Abdominal Lesion

ABSTRACT This report describes a horse presenting ileal impaction that went through a right flank laparotomy procedure while standing. The decision to use this technique was made under the influence of several factors: the patient exhibited a calm temperament and demonstrated responsiveness to the analgesic treatment for pain control; the abdominal lesion was amenable to correction by a standing right flank approach. Also, the owner reported financial problems. Ileal obstruction was relieved successfully, and the horse recovery was satisfactory. This case highlights that, in specific cases of colic syndrome, the use of surgical procedures in the standing position might be a viable option and promote fast recovery.

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ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation) randomised controlled, feasibility in older people trial: a study protocol

BMJ Open ◽

10.1136/bmjopen-2019-032111 ◽

2019 ◽

Vol 9 (7) ◽

pp. e032111 ◽

Cited By ~ 1

Author(s):

Dawn van Berkel ◽

Terence Ong ◽

Avril Drummond ◽

Paul Hendrick ◽

Paul Leighton ◽

...

Keyword(s):

Older People ◽

Surgical Management ◽

Pain Control ◽

Insufficiency Fracture ◽

Safety Data ◽

Fragility Fractures ◽

Feasibility Trial ◽

Sacral Insufficiency Fracture ◽

Qualitative Interview Study ◽

Randomised Controlled

IntroductionPelvic fragility fractures (PFF) are common in older people and associated with a significant burden of mortality and morbidity. This is related to the challenges of appropriate pain control and early mobilisation. The current standard for treatment of PFF is non-surgical management. Minimally invasive surgical techniques for sacral fracture stabilisation have been shown to improve outcomes in terms of pain control and mobility, and they are safe. Randomised controlled trials are required before recommendations can be made for surgical management of PFF to become the new standard of care. This feasibility study will explore several uncertainties around conducting such a trial.Methods and analysisASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation) is a single-site randomised controlled, parallel-arm, feasibility trial of surgical stabilisation versus non-surgical management of acute sacral fragility fractures in people aged 70 years and over. Patients will be randomised to either surgical or non-surgical group on a 1:1 ratio. Follow-up of participants will occur at 2, 4 and 12 weeks with safety data collected at 52 weeks. Primary objectives are to determine feasibility and design of a future trial, including outcomes on recruitment, adherence to randomisation and safety. This will be supplemented with a qualitative interview study of participants and clinicians. Secondary objectives will inform study design procedures to determine clinical and economic outcomes between groups, including scored questionnaires, analgesia requirements, resource use and quality of life data. Data analysis will be largely descriptive to inform outcomes and future sample size.Ethics and disseminationEthical approval was granted by the North East Newcastle and North Tyneside 2 Research Ethics Committee (reference 18/NE/0212). ASSERT was approved and sponsored by Nottingham University Hospitals NHS Trust (reference 18HC001) and the Health Research Authority (reference IRAS 232791). Recruitment is ongoing. Results will be presented at relevant conferences and submitted to appropriate journals on study completion.Trial registration numberISRCTN16719542; Pre-results.

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Comparison between preoperative and post-operative administration of paracetamol, ibuprofen and mefenamic acid for post-extraction pain control

Biomedical Research and Therapy ◽

10.15419/bmrat.v7i5.606 ◽

2020 ◽

Vol 7 (5) ◽

pp. 3794-3798

Author(s):

Govindaraj Padmanabha Kumar ◽

Chew Shu-Lyn ◽

Goi Ee Win ◽

Lee Win Sie ◽

Nur Fatin Khaleeda binti Lakman ◽

...

Keyword(s):

Pain Management ◽

Mefenamic Acid ◽

Pain Control ◽

Dental Treatment ◽

Positive Impact ◽

Cumulative Number ◽

Acute Pain Management ◽

Analgesic Treatment ◽

Treatment Groups ◽

Post Operative Pain

Pain is a common aftereffect following a dental treatment, especially extractions. Hence, the main aim of the study was to compare the effect of pre-operative and post-operative analgesic usage on post-operative pain management following dental treatment. Moreover, the efficacies of three types of painkillers (Paracetamol, Ibuprofen and Mefenamic Acid) in pain relief were also evaluated. Volunteers (n = 120) who were undergoing extraction participated in this study and were randomly divided into two groups. One group consisting of 60 participants were given pre- and post-operative analgesics while another group (n = 60) received post-operative analgesics only. A visual scale was used to record pain from zero to 56 hours post-operatively at 8-hour intervals. The results showed that patients who were taking analgesics pre-operatively experienced significantly (p = 0.0045) less pain compared to those who had taken post-operative analgesics only However, a lower cumulative number of moderate and severe experiences of post-extraction pain was recorded for the pre- and post-operative analgesic treatment groups as compared to the postoperative only analgesic treatment group; no significant differences were observed. Moreover, no significant differences were observed among the analgesics used in this study as well. On the basis of these results, we conclude that preoperative analgesic usage has a positive impact on postextraction acute pain management.

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Clinical pharmacology of analgesics in old age and frailty

Reviews in Clinical Gerontology ◽

10.1017/s0959259809990232 ◽

2009 ◽

Vol 19 (2) ◽

pp. 103-118 ◽

Cited By ~ 12

Author(s):

Sarah J Mitchell ◽

Sarah N Hilmer ◽

Andrew J McLachlan

Keyword(s):

Clinical Pharmacology ◽

Older People ◽

Old Age ◽

Pain Control ◽

Individual Variability ◽

Rational Basis ◽

Pharmacokinetics And Pharmacodynamics ◽

Age Related ◽

High Prevalence ◽

Prevalence Of Pain

SummaryThere is a high prevalence of pain in older people. Optimal assessment and management of pain in this population is challenging. The pharmacokinetics and pharmacodynamics of analgesic medications are affected by ageing and frailty, as well as by intercurrent medical conditions and their treatments. This review describes what is currently understood about the impacts of old age and frailty on the clinical pharmacology of commonly used analgesics, to provide a rational basis for the use of these medicines. In view of the wide age-related inter-individual variability in pharmacokinetics and pharmacodynamics of analgesic medications, monitoring of clinical response and adverse effects is essential to optimize pain control in older people.

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