Pain management

2019 ◽  
pp. 383-390
Author(s):  
William L Yancey ◽  
Walter J. Meyer ◽  
Lee C. Woodson ◽  
Rene Przkora
Keyword(s):  
Pain Management ◽  
Burn Severity ◽  
Anxiety And Depression ◽  
Multimodal Approach ◽  
Contributing Factors ◽  
Similar Variation ◽  
Psychological Therapies ◽  
Basic Level ◽  
Burn Patient

Treatment of pain in the burn patient presents a unique set of challenges. The pathology of pain with these injuries, while consistent at its most basic level, varies considerably with factors such as the burn severity and the stage of treatment/healing. The experience of pain shows similar variation. The assessment of pain and recognition of contributing factors such as anxiety and depression require vigilance and persistence, especially among paediatric populations. Multiple techniques for the measurement of pain in patients have been evaluated and are suitable for routine use. A multimodal approach to the treatment of pain should be employed, including pharmacological, surgical, non-pharmacological, and psychological therapies.

Pain Management of the Burn Patient

2009 ◽  
Vol 24 (7) ◽  
pp. 1-5
Author(s):  
Clifford Gevirtz
Keyword(s):  
Pain Management ◽  
Burn Patient

scholarly journals Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (EXPAREL)

2015 ◽  
Vol 5 (1) ◽  
pp. 6-9
Author(s):  
Vani Sabesan ◽  
Timothy R Jelsema ◽  
Daniel J Lombardo
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Well Being ◽  
Multimodal Approach ◽  
Wound Infiltration ◽  
Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Postsurgical Pain ◽  
Limited Efficacy

ABSTRACT Adequate postoperative pain management after an orthopaedic procedure is critical for patient well-being, acceptable clinical outcomes and patient satisfaction. Current literature suggests over 80% of surgical patients’ state they have moderate to severe pain within 24 hours postoperatively. The standard in pain management for more than 40 years has been opioids, medications known for their many adverse effects and limited efficacy. Recently, a multimodal approach to pain control has been sought after for optimal postoperative pain management. This approach utilizes multiple methods of pain management, such as nerve blocks, wound infiltration with local anesthetics and oral analgesics, to concomitantly reduce postoperative pain. Liposomal bupivacaine, EXPAREL, has been shown to reduce pain for as long as 96 hours postoperatively in select studies. These studies have included both hard and soft-tissue procedures. The goal of this review is to examine the literature on EXPAREL and provide a comprehensive presentation for orthopaedic surgeons to apply to their practices. Sabesan V, Jelsema TR, Lombardo DJ. Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (EXPAREL). The Duke Orthop J 2015;5(1):6-9.

Craniotomy

2019 ◽  
pp. 221-245
Author(s):  
Roxana Grasu ◽  
Sally Raty
Keyword(s):  
Risk Factors ◽  
Pain Management ◽  
Side Effects ◽  
Respiratory Depression ◽  
Pain Control ◽  
Sensory Nerves ◽  
Current Evidence ◽  
Multimodal Approach ◽  
Perivascular Nerves ◽  
Persistent Headache

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

A Multimodal Approach to Pain Management for Patients with Chronic Back Pain: Outcome Measures at 1 Year

2019 ◽  
Vol 23 (8) ◽  
Author(s):  
Jonathan P. Eskander ◽  
Burton D. Beakley ◽  
Si Zhang ◽  
Jacquelyn Paetzold ◽  
Bharat Sharma ◽  
...  
Keyword(s):  
Back Pain ◽  
Pain Management ◽  
Outcome Measures ◽  
Chronic Back Pain ◽  
Multimodal Approach ◽  
Pain Outcome

The English Improving Access to Psychological Therapies (IAPT) Program

2015 ◽  
Author(s):  
David M. Clark
Keyword(s):  
Best Practice ◽  
Stepped Care ◽  
Anxiety And Depression ◽  
Care Model ◽  
Intensive Training ◽  
Practice Recommendations ◽  
Psychological Therapies ◽  
The United Kingdom ◽  
Evidence Based Treatments ◽  
National Effort

Chapter 4 describes the Improving Access to Psychological Therapies Program in the United Kingdom, a sweeping national effort to ensure availability of evidence-based treatments by providing intensive training and utilizing a stepped-care model consistent with best-practice recommendations for the treatment of anxiety and depression.

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

2020 ◽  
Vol 13 ◽  
Author(s):  
Marianne Fanous ◽  
Jo Daniels
Keyword(s):  
Anxiety Disorder ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
List Type ◽  
Generalised Anxiety Disorder ◽  
Post Intervention ◽  
Attrition Rates ◽  
Clinical Recovery ◽  
Psychological Therapies ◽  
Group Cbt

Abstract Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.

Stress, Anxiety and Depression Among Parents of Children With Autism Spectrum Disorder

2004 ◽  
Vol 14 (2) ◽  
pp. 151-161 ◽  
Author(s):  
Vicki Bitsika ◽  
Christopher F. Sharpley
Keyword(s):  
Autism Spectrum Disorder ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Anxiety And Depression ◽  
Contributing Factors ◽  
Personal Support ◽  
Behavioural Difficulties ◽  
Clinically Depressed ◽  
Support Mechanisms ◽  
Anxiety Depression

In a replication of a previous study of the incidence and contributing factors in anxiety, depression and stress in Victorian parents of a child with autism spectrum disorder (ASD), a sample of 107 Gold Coast parents completed a questionnaire that assessed their demographic backgrounds, anxiety and depression scores on standardised inventories, and also tapped several aspects of those factors that may have contributed to their wellbeing. Over 90% of parents reported that they were sometimes unable to deal effectively with their child's behaviour. Nearly half of the participants were severely anxious and nearly two thirds were clinically depressed. Factors that emerged as significant in differentiating between parents with high versus low levels of anxiety and depression included access to family support, parents' estimation of family caregivers' expertise in dealing with the behavioural difficulties of a child with ASD, and parental health. Parents' suggestions for personal support services are reported, and some comparisons across the data from the two states are made, with suggestions for further research into parent support mechanisms.

Use of a comprehensive survey as a first step in addressing clinical competence of physicians-in-training in the management of pain

2005 ◽  
Vol 1 (2) ◽  
pp. 98 ◽  
Author(s):  
Mark Chaitowitz, MBBCh ◽  
William Tester, MD ◽  
Glenn Eiger, MD
Keyword(s):  
Internal Medicine ◽  
Pain Management ◽  
Residency Program ◽  
Clinical Competence ◽  
Initial Step ◽  
Educational Interventions ◽  
Pain Scale ◽  
Contributing Factors ◽  
Management Interventions ◽  
Comprehensive Survey

Deficiencies in practice, knowledge, and competence among physicians are important contributing factors to the unsatisfactory level of analgesic care in hospitalized patients. By way of a comprehensive survey, we characterized these deficiencies within an internal medicine residency program as an initial step in designing remedial educational strategies. To do so, an anonymous 43-item survey was administered to residents in an internal medicine program. A total of 61 residents (69 percent) responded.The results indicated that patient-controlled analgesia (PCA), a standardized pain scale, and an opioid equivalence table were underused. Competence in opioid conversion was suboptimal, but completion of an oncology rotation and familiarity with the opioid equivalence table predicted greater competence in this area (p = 0.007 and p = 0.001, respectively).Self-perceptions of adequacy of training and painmanagement competence were predictors of knowledge (p = 0.026 and p = 0.038, respectively). Attitudes regarding opioid analgesia were generally satisfactory (i.e., low “opiophobia” score), although the risk of addiction was still overestimated.The characterization of deficiencies in pain management in a residency program is an essential step in the design and implementation of educational interventions. Administration of a comprehensive survey is a simple and effective method of gathering this data and has the additional benefit of promoting awareness of pain management issues. Our experience served to establish, among other findings, the didactic value of experience on an oncology floor; this result substantiates the value of practical experience in the gaining of clinical competence in pain management. Interventions that capitalize on the findings of the survey and the interest in pain management generated by its administration are currently ongoing at our institution.

Sign in / Sign up

Export Citation Format

Share Document