scholarly journals Multimodal Pain Management in the Setting of Palliative Care

2021 ◽  
Author(s):  
Marija V. Sholjakova ◽  
Vesna M. Durnev
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Additional Treatment ◽  
Therapeutic Approaches ◽  
Multimodal Pain Management ◽  
Addictive Drugs ◽  
Analgesic Therapy ◽  
Good Organization

Pain as an integral part of palliative care (PC) is often present at the end of the life. Today, many different analgesics from opioids and non- opioids origin are in use. The integration of their use is the most effective method for pain relief. The aim of this chapter is to discuss different therapeutic approaches to pain management in palliative care. Palliative care is being confronted between the expectations and the possibilities to provide an efficient relief from the symptoms, the pain and the stress. The possibility to use opioids for pain management, with all side effects, and non-addictive drugs as additional treatment, improves the quality and the duration of life for the patients in palliative care. Since the origin of the pain is different, the use of analgesic therapy should be individualized and adapted to the real need of every person. Finally, only a good organization and institutionalization of palliative care in the society could allow for better prevention of suffering at the end of the life.

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 POST-OPERATIVE PAIN RELIEF FOR LOWER ABDOMINAL SURGERY

2005 ◽  
Vol 12 (03) ◽  
pp. 340-345
Author(s):  
ROBINA FIRDOUS
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Opioid Receptors ◽  
Acute Pain ◽  
Alternate Route ◽  
Parenteral Route ◽  
Group I ◽  
Post Operative Pain

The severity of post-operative pain and the lack of efforts in relievingit have led to the involvement of Anaesthesiologists in the management of post-operative and acute pain. Parenteralopiates have been utilized for post-operative pain management. The identification of the opioid receptors on substantiagelatinosa has provided an alternate route i.e 1 the epidural route - for administering opiates. Objectives: To evaluateand compare the efficacy and side effects of parenteral Buprenorphine with those of Extradural Buprenorphine.Setting: Department of Anaesthesia, District Headquarter Hospital, Faisalabad. Period: The data was collected duringthe last three and a half years. Materials and Methods: Sixty adult patients of either sex and ages ranging from 35-45years, who underwent lower abdominal surgery, were randomly selected for the study. They were equally divided intotwo groups. Group I patients were administered Buprenorphine 0.3 mg through the epidural catheter in extraduralspace. Group II patients were given Buprenorphine 0.3 mg intramuscularly. Results: Buprenorphine through theepidural route gives better analgesia with fewer side effects as compared with the parenteral route.

scholarly journals Comparative Study in the Management of Postoperative Pain with High Dose Intravenous Paracetamol versus Tramadol

2021 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Tanudeep Kaur ◽  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Emotional Experience ◽  
Postoperative Pain Management ◽  
Economic Benefits ◽  
High Dose ◽  
Postoperative Patient ◽  
Intravenous Paracetamol

Pain is an unpleasant sensory and emotional experience causing agony and several side effects in a postoperative patient. Thus effective postoperative pain management has a humanitarian role with additional medical and economic benefits Paracetamol (PCM) has been widely used as an effective analgesic and antipyretic for over a century with an established safety profile, and Tramadol is a commonly used intravenous drug for postoperative pain relief.

scholarly journals “No thanks, I don’t want to see snakes again”: a qualitative study of pain management versus preservation of cognition in palliative care patients

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Pete Wegier ◽  
Jaymie Varenbut ◽  
Mark Bernstein ◽  
Peter G. Lawlor ◽  
Sarina R. Isenberg
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Pain Management ◽  
Pain Relief ◽  
Decision Aids ◽  
Opioid Analgesics ◽  
Structured Interviews ◽  
Difficult Decision ◽  
Home Based ◽  
Control Pain

Abstract Background Towards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them. Methods We conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis. Results Thirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. Conclusions Decision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

scholarly journals Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials

2017 ◽  
Vol 2 (20;2) ◽  
pp. sE33-sE52 ◽  
Author(s):  
Chi-Wai Cheung
Keyword(s):  
Clinical Trials ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Analgesic Efficacy ◽  
Postoperative Pain Management ◽  
Acute Postoperative Pain

Background: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. Objectives: To evaluate the use of oral oxycodone for acute postoperative pain management. Study Design: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Methods: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were “oral strong opioids,” “postsurgical,” “postoperative,” “post-surgical,” and “postoperative.” Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. Results: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. Limitation: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. Conclusion: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics. Key words: Postoperative, pain, analgesia, oral oxycodone, opioid

scholarly journals “No thanks, I don’t want to see snakes again”: A qualitative study of pain management versus preservation of cognition in palliative care patients

2020 ◽  
Author(s):  
Pete Wegier ◽  
Jaymie Varenbut ◽  
Mark Bernstein ◽  
Peter G Lawlor ◽  
Sarina R Isenberg
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Pain Relief ◽  
Decision Aids ◽  
Opioid Analgesics ◽  
Structured Interviews ◽  
Difficult Decision ◽  
Pain Medications ◽  
Home Based ◽  
Control Pain

Abstract BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

scholarly journals “No Thanks, I Don’t Want to See Snakes Again”: A Qualitative Study of Pain Management Versus Preservation of Cognition in Palliative Care Patients

2020 ◽  
Author(s):  
Pete Wegier ◽  
Jaymie Varenbut ◽  
Mark Bernstein ◽  
Peter G Lawlor ◽  
Sarina R Isenberg
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Pain Management ◽  
Pain Relief ◽  
Decision Aids ◽  
Opioid Analgesics ◽  
Structured Interviews ◽  
Difficult Decision ◽  
Home Based ◽  
Control Pain

Abstract BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

scholarly journals Lidocaine and bupivacaine as part of multimodal pain management in a C57BL/6J laparotomy mouse model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mattea S. Durst ◽  
Margarete Arras ◽  
Rupert Palme ◽  
Steven R. Talbot ◽  
Paulin Jirkof
Keyword(s):  
Drinking Water ◽  
Pain Management ◽  
Side Effects ◽  
Local Anesthesia ◽  
Physiological Changes ◽  
Sevoflurane Anesthesia ◽  
Multimodal Pain Management ◽  
Surgical Pain ◽  
Combination Of Methods ◽  
Target Dosage

AbstractWhile the use of local anesthesia as part of multimodal pain management is common practice in human and veterinarian surgery, these drugs are not applied routinely in rodent surgery. Several recommendations on the use of local anesthesia exist, but systematic studies on their efficacy and side effects are lacking. In the present study, male and female C57BL/6J mice were subjected to a sham vasectomy or a sham embryo transfer, respectively. We tested whether a mixture of subcutaneously injected Lidocaine and Bupivacaine in combination with systemic Paracetamol applied via drinking water results in superior pain relief when compared to treatment with local anesthesia or Paracetamol alone. We applied a combination of methods to assess behavioral, emotional, and physiological changes indicative of pain. Voluntary Paracetamol intake via drinking water reached the target dosage of 200 mg/kg in most animals. Local anesthesia did not lead to obvious side effects such as irregular wound healing or systemic disorders. No relevant sex differences were detected in our study. Sevoflurane anesthesia and surgery affected physiological and behavioral measurements. Surprisingly, Paracetamol treatment alone significantly increased the Mouse Grimace Scale. Taken together, mice treated with a combination of local anesthesia and systemic analgesia did not show fewer signs of post-surgical pain or improved recovery compared to animals treated with either local anesthesia or Paracetamol.

scholarly journals Analgesic combinations as a strategy for pain relief and isobolographic analysis

2015 ◽  
Vol 3 (6) ◽  
Author(s):  
Aracely Evangelina Chávez-Piña ◽  
Arlette Guadalupe Arroyo-Lira
Keyword(s):  
Natural Products ◽  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Adverse Effects ◽  
Therapeutic Effect ◽  
Fixed Ratio ◽  
Opioid Analgesics ◽  
Isobolographic Analysis ◽  
Inflammatory Drugs

Pain is a multidimensional sensory experience that is intrinsically unpleasant and associated with hurting and soreness, it is essentially a sensation. Pain has strong, cognitive and emotional components, it is linked to, or described in terms of suffering. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and opioid analgesics are two of the most common types of drugs used for pain management. However, the use of these analgesics is limited by the presence of significant adverse effects. A useful practice is a combination of two agents with the same therapeutic effect wherein each agent is administered to obtain additive, synergistic or subadditive interaction in a fixed ratio. If the combination resulted in addition or synergism, the doses employed by each agent are reduced, then the side effects are absent; this kind of study is named isobolographic analysis. In this review, the authors summarized previous reports of the combination of NSAIDs with opioids and natural products as an alternative in the pain management.

Paediatric cancer pain

2013 ◽  
pp. 157-170
Author(s):  
Jennifer Hickman ◽  
Jaya Varadarajan ◽  
Steven J. Weisman
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
End Of Life ◽  
Systematic Approach ◽  
Pain Treatment ◽  
Paediatric Cancer ◽  
Treatment Protocols ◽  
Multimodal Pain Management

Chapter 17 discusses paediatric cancer pain, and how each patient seems to follow a unique trajectory and, for the pain clinician, will present unique challenges that require agility and flexibility to design satisfactory pain treatment protocols. Using a systematic approach that encompasses the notion that pain in paediatric cancer is usually the result of multiple intersecting causes will usually provide satisfactory results for the patients and their watchdog families supervising their care. For the continually decreasing numbers of children who cannot survive their disease, our palliative care colleagues can continue multimodal pain management in conjunction with their pain management resources to ensure a dignified and comfortable end of life.

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