Pain Control: How Aging Affects Pain Management

1998 ◽  
Vol 98 (6) ◽  
pp. 12
Author(s):  
Christine L. Pasero ◽  
Barbara Reed ◽  
Margo McCaffery
Keyword(s):  
Pain Management ◽  
Pain Control

A Multimodal Pain Management Regimen for Open Treatment of Distal Radius Fractures: A Randomized Blinded Study

Hand ◽  
2020 ◽  
pp. 155894472097514
Author(s):  
Julian Zangrilli ◽  
Nura Gouda ◽  
Armen Voskerijian ◽  
Mark L. Wang ◽  
Pedro K. Beredjiklian ◽  
...  
Keyword(s):  
Pain Management ◽  
Distal Radius ◽  
Bone Healing ◽  
Pain Control ◽  
Distal Radius Fractures ◽  
Study Group ◽  
Radius Fractures ◽  
Multimodal Pain Management ◽  
Regional Block ◽  
Rebound Increase

Background Adequate pain control is critical after outpatient surgery where patients are not as closely monitored. A multimodal pain management regimen was compared to a conventional pain management method in patients undergoing operative fixation for distal radius fractures. We hypothesized that there would be a decrease in the amount of narcotics used by the multimodal group compared to the conventional pain management group, and that there would be no difference in bone healing postoperatively. Methods Forty-two patients were randomized into 2 groups based on pain protocols. Group 1, the control, received a regional block, acetaminophen, and oxycodone. Group 2 received a multimodal pain regimen consisting of daily doses of pregabalin, celecoxib, and acetaminophen up until postoperative day (POD) #3. They also received a regional block with oxycodone for breakthrough pain. Results From POD#3 to week 1, there was a significant increase in oxycodone use in the study group correlating with the point in time when the multimodal regimen was discontinued. The shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) scores taken at 2 weeks postoperation showed a significantly lower average score in the study group compared to the control. There was no difference in bone healing. Conclusions The 2 regimens yielded similar pain control after surgery. The rebound increase in narcotic use after the multimodal regimen was discontinued, and significant difference in QuickDASH scores seen at 2 weeks postoperatively supported that multimodal regimens may not necessarily lead to decreased narcotic use in outpatient upper extremity surgery, but in the short term are shown to improve functional status.

scholarly journals Pain management practice patterns after hip arthroscopy: an international survey

2020 ◽  
Author(s):  
Flávio L Garcia ◽  
Brady T Williams ◽  
Bhargavi Maheshwer ◽  
Asheesh Bedi ◽  
Ivan H Wong ◽  
...  
Keyword(s):  
Pain Management ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Sports Medicine ◽  
Management Practice ◽  
Professional Organizations ◽  
International Survey ◽  
Nerve Blocks ◽  
Optimal Approach ◽  
Answer Choice

Abstract Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

scholarly journals International survey: real-world pain management strategies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Hagen ◽  
A Georgescu
Keyword(s):  
Pain Management ◽  
Real World ◽  
Pain Control ◽  
Online Survey ◽  
Management Strategies ◽  
Pain Medication ◽  
International Survey ◽  
Nationally Representative ◽  
Online Panels ◽  
Control Pain

Abstract Background Pain is a nearly universal experience, but little is known about how people treat pain. This international survey assessed real-world pain management strategies. Methods From 13-31 January, 2020, an online survey funded by GSK Consumer Healthcare was conducted in local languages in Australia, Brazil, Canada, China, Colombia, France, Germany, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Poland, Russia, Spain, Sweden, UK, and USA. Adults were recruited from online panels of people who agreed to participate in surveys. Quotas ensured nationally representative online populations based on age, gender, and region. Results Of 19,000 people (1000/country) who completed the survey, 18,602 (98%) had ever experienced physical pain; 76% said they would like to control their pain better. Presented with 17 pain-management strategies and asked to select the ones they use in the order of use, respondents chose an average of 4 strategies each. The most commonly selected strategies were pain medication (65%), rest/sleep (54%), consult a doctor (31%), physical therapy (31%), and nonpharmacologic action (eg, heat/cold application; 29%). Of those who use pain medication, 56% take some other action first. Only 36% of those who treat pain do so immediately; 56% first wait to see if it will resolve spontaneously. Top reasons for waiting include a desire to avoid medication (37%); willingness to tolerate less severe pain (33%); concerns about side effects (21%) or dependency (21%); and wanting to avoid a doctor's visit unless pain is severe or persistent (21%). Nearly half (42%) of those who take action to control pain have visited ≥1 healthcare professional (doctor 31%; pharmacist 18%; other 17%) about pain. Conclusions This large global survey shows that people employ a range of strategies to manage pain but still wish for better pain control. Although pain medication is the most commonly used strategy, many people postpone or avoid its use. Key messages More than three-quarters (76%) of respondents across countries seek better pain control. Pain medication and rest/sleep consultation are the most common pain management strategies. More than half of respondents (56%) wait to see if pain will resolve spontaneously before taking any action, and 56% of those who use pain medication try some other approach first.

Pain Management in the Cancer Patient

1998 ◽  
Vol 11 (5) ◽  
pp. 349-373 ◽  
Author(s):  
Kristi L. Lenz ◽  
Eileen M. Marley
Keyword(s):  
Pain Management ◽  
Cancer Patient ◽  
Cancer Pain ◽  
Pain Control ◽  
Cancer Pain Management ◽  
Basic Principles ◽  
Adequate Pain Management

Of the over one million patients diagnosed with cancer each year, 30 percent will have pain at diagnosis and up to 85 percent will have pain as their disease progresses. Adequate pain management continues to be hindered by multiple patient-and clinician-related barriers; however, with increased awareness and knowledge, the pharmacy practitioner can play a key role in facilitating pain management. This review will focus on the mechanisms of cancer pain, the role of non-opioids, opioids, and adjuvant agents in the treatment of cancer pain, and the basic principles of cancer pain management that allow 70 to 90 percent of patients to achieve excellent pain control.

The experience of pain among cancer patients at the University of the Philippines: Philippine General Hospital Cancer Institute—A cross-sectional study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24078-e24078
Author(s):  
Harold Nathan C. Tan ◽  
Rogelio Nona Velasco ◽  
Lance Isidore Garcenila Catedral ◽  
Michael Ducusin San Juan ◽  
Corazon Ngelangel ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Patients ◽  
Pain Control ◽  
Severe Pain ◽  
Cross Sectional Study ◽  
The Philippines ◽  
Pain Interference ◽  
Cancer Center ◽  
Cross Sectional ◽  
Adequate Pain Management

e24078 Background: Pain is one of the most common and dreaded sequelae of cancer, occurring in approximately 55% of patients. The experience of pain takes a toll on the patients’ quality of life. However, many patients do not receive adequate pain management. This study aimed to determine the prevalence of pain, its severity, and the adequacy of pain management among cancer patients in the Philippines. Methods: A cross-sectional study was conducted at a representative cancer center in the Philippines, enrolling 351 cancer patients. Pain severity was assessed using the Brief Pain Inventory-Short Form (BPI-SF) Filipino. The BPI evaluates pain severity and its impact on daily functioning (pain interference). To ascertain the adequacy of pain control, the pain management index (PMI) was calculated by subtracting the subtracting the severity of pain reported by the patient from the type of analgesic treatment received. Logistic regression analysis was conducted to evaluate the factors associated with worst pain and adequacy of pain management. Data were analyzed using Stata version 16.0, with statistical significance set at p < 0.05. Results: Three hundred three cancer patients (86.3%) experienced pain. Approximately 3 out of 5 patients (n = 208) did not receive adequate pain control, and one-third of patients experienced severe pain (n = 121). Patients who reported severe pain interference (n = 110) had three times greater odds to experience severe pain (OR 3.2, 95% CI 1.82-5.61, p < 0.001). Those patients who had regular follow up were 65% less likely to experience severe pain (OR 0.35, 95% CI 0.16 – 0.78, p = 0.01). Patients who used pain medications (n = 196) were 14 times more likely to experience adequate pain management (OR 14.19, 95% CI 6.53 – 30.83, p < 0.001). Patients who were referred to pain service (n = 25) were seven times more likely to report adequate pain control (OR 6.62, 95% CI 2.50 – 17.56, p < 0.001). Conversely, those patients who reported a severe rating on total pain interference were 75% less likely to experience adequate pain management (OR 0.25, 95% CI 0.17 – 0.35, p < 0.001). Conclusions: Unexpectedly, there was a high prevalence of pain among cancer patients at a representative cancer center in the Philippines. Pain exerts a heavy toll on patients, affecting daily functioning. The undertreatment of pain discovered in this study (59% of cancer patients) is alarming. Timely pain evaluation can help identify the presence of pain and the need for appropriate use of analgesics. The assessment and management of pain is a critical component of cancer care that should not be neglected.

Pain Management

2019 ◽  
pp. 116-131
Author(s):  
Judith A. Paice
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
End Of Life ◽  
Family Communication ◽  
Pain Control ◽  
Care Program ◽  
Palliative Care Program ◽  
Institutional Policies ◽  
Team Members ◽  
Serious Illness

Pain is one of the most common and most feared symptoms experienced by those with serious illness. The nurse’s role begins with assessment and continues through the development of a plan of care and its implementation. During this process, the nurse provides education and counseling to the patient, family, and other team members. Nurses also are critical for developing institutional policies and monitoring outcomes that ensure good pain management for all patients within their palliative care program. To provide optimal pain control, all healthcare professionals must understand the frequency of pain at the end of life, the barriers that prevent good management, the comprehensive assessment of this syndrome, and the treatments used to provide relief. Effective pain control and alleviation of suffering is highly dependent upon the strength of clinician, patient, and family communication and relationship. These are key strengths of nursing, at all phases of palliative care.

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.

scholarly journals Fascia Iliaca Compartment Block for Perioperative Pain Management of Geriatric Patients with Hip Fractures: A Systematic Review of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Hao-yang Wan ◽  
Su-yi Li ◽  
Wei Ji ◽  
Bin Yu ◽  
Nan Jiang
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Pain Relief ◽  
Hip Fractures ◽  
Pain Control ◽  
Geriatric Patients ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Perioperative Pain Management ◽  
Fascia Iliaca Compartment Block

Background. With continuous increase of the aging population, the number of geriatric patients with fragility hip fractures is rising sharply, and timely surgery remains the mainstay of treatment. However, adequate and effective pain control is the precondition of satisfactory efficacy. This systematic review aimed to summarize the use of fascia iliaca compartment block (FICB) as an analgesic strategy for perioperative pain management in geriatric patients with hip fractures. Methods. PubMed and Embase databases were searched for English published randomized controlled trials (RCTs) reporting application of FICB for pain control of the older adults with hip fractures between January 1st, 2000, and May 31st, 2020. The modified Jadad scale was used to evaluate quality of the RCTs included. Primary outcomes of the eligible RCTs were presented and discussed. Results. A total of 27 RCTs with 2478 cases were included finally. The present outcomes suggested, after admission or in the emergency department (ED), FICB can provide patients with equal or even better pain relief compared with the conventional analgesia methods, which can also reduce additional analgesic consumptions. While, before positioning for spinal anesthesia (SA), FICB is able to offer superior pain control, facilitating SA performance, after surgery FICB can effectively alleviate pain with decreased use of additional analgesics, promoting earlier mobilization and preventing complications. Conclusions. FICB is a safe, reliable, and easy-to-conduct technique, which is able to provide adequate pain relief during perioperative management of geriatric patients with hip fractures.

Survey of Pain Management Therapy Provided for Children With Sickle Cell Disease

1992 ◽  
Vol 31 (4) ◽  
pp. 211-214 ◽  
Author(s):  
Charles H. Pegelow
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Clinical Research ◽  
Sickle Cell ◽  
Special Interest ◽  
Pain Control ◽  
Control Methods ◽  
Cell Disease ◽  
Narcotic Analgesics ◽  
Principal Investigators

A questionnaire was sent to principal investigators of NIH-sponsored clinical research in sickle cell disease. Twenty of 21 respondents indicated they used parenteral narcotic analgesics for pain episodes sufficiently severe to warrant hospitalization. Eleven used meperidine; seven, morphine; and one each, nalbuphine, hydromorphone, and acetaminophen with codeine. They gave the agents at frequent, regular intervals or by continuous infusion. A total of 41 of more than 3,500 patients required chronic transfusion for pain control. Complications included meperidine-associated convulsions reported by nine respondents and addiction by six. This information indicates that vigorous pain-control methods are used at institutions having a special interest in providing medical care for children with sickle cell disease.

Pain Management

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Side Effects ◽  
Pain Control ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Narcotic Analgesics

Adequate pain control has a high priority. In any acute neurologic pain syndrome it must be assumed that pain management is possible, effective, and simple; unfortunately, most patients in pain have been poorly managed. The pharmacopeia of pain management is growing and changing and several trends have been noted. Pain is underreported in the intensive care unit and should be treated when indicated. Acetaminophen is often the first agent used in pain management. Next are weak narcotic analgesics which could have less severe side effects than stronger opioid analgesics. This chapter discusses types of pain in the neurosciences intensive care unit and specific pharmacologic approaches.

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