Anaesthesiologists predominantly treat acute postoperative pain. Records of their success have been documented, but it has been demonstrated in only a few studies that alleviating this form of pain is effective. The classic Apfelbaum study of 2003 revealed that in the period 1995–2003, very little progress was made in managing pain. Approximately 80% of all surgical patients experienced moderate to extreme pain following their surgery. Reports from the recent European PAIN OUT Symposium 2014 were also not encouraging as it was revealed that 40% of patients experienced severe postoperative pain, and almost 50% of patients wished that they had received better pain therapy. Is this acceptable today? I believe not. This fact merely serves to demonstrate that the need identified by the two world bodies exists! We need to focus our attention on the management of acutepain, as the effective treatment of acutepain must become a fundamental component of quality patient care.
dissatisfaction, comorbid mental disorders, and the socioeconomic cost among suffers and for society. From the biopsychosocial approach, pain experience has been understood as a complex phenomenon of objective and subjective experiences that account for sensory experiences as well as emotions and cognitions. Stress has been found to impact acute and chronic pain experiences. While there are several models of stress, the transactional model of stress serves a framework to explain the individual differences in stress responses. In particular, threat appraisals (primary appraisal) and pain catastrophizing (secondary appraisal) have been found to be associated with poorer pain-related outcomes. On the other hand, mindfulness has been found to be beneficial to stress responses and pain-related outcomes. Therefore, this study examined how cognitive stress appraisals, pain catastrophizing, and their interaction influence the pain experience in terms of pain ratings and pain tolerance as well as physiological reactivity of cardiovascular function and cortisol to an induced acutepain. The study also examined how trait mindfulness could influence these relations. Ninety-three undergraduate participants at the University of Michigan-Dearborn engaged in a cold pressor task and completed several self-reported measures such as the Stress Appraisal Measure (SAM), the Pain Catastrophizing Scale, the Mindfulness Attention
The number of available studies about acutepain treat- ment regarding postoperative pain treatment is satisfying, but inadequate with regard to pain treatment on medical wards. Thus, the empirical research situation reflects the underrepresentation of APS at medical wards. It is becom- ing clear that acutepain treatment has still not found its way into the routine procedures of hospitals, although the results of the studies show for several years a strin- gent evidence of the benefit of APS for the improvement of acutepain treatment. Looking at the used scales to measure the intensity of pain it is striking that the margin of interpretation of the obtained pain relief is large. This is a hindrance for a standardisation of acutepain treat- ment. Interface problems are too seldom considered and analyzed in the studies.
Pain relief intervention can include pharmalogical and non pharmacological interventions or a combination of interventions. Although pharmacological interventions are often an essential component of an analgesia treatment plan, the benefits of nonpharmacological pain relief interventions cannot be underestimated. The aims of nonpharmacological pain relief interventions are to decrease the perception of pain by frequently focusing on interventions that promote distractions, relaxation and reduce stressful emotions such as anxiety. Preparatory information, relaxation and distraction techniques activate inhibitory systems located in the brain that result in a reduction of distress and related muscle tension (Summer and Puntillo, 2001). The AcutePain Management Guidelines developed by the Agency for Health Care Policy and Research (AHCPR) state that patients who receive preoperative information related to pain management reported less pain and have shorter lengths of stay that patients who do not receive this specialized teaching (Agency for Health Care Policy and Research, 1992). Preparatory information given before surgery is effective in helping patients cope and manage their pain better (Knoerl et al., 1999).
Abstract: This article provides a historical and pharmacological overview of a new opioid analgesic that boasts an extended-release (ER) formulation designed to provide both immediate and prolonged analgesia for up to 12 hours in patients who are experiencing acutepain. This novel medication, ER oxycodone/acetaminophen, competes with current US Food and Drug Administration (FDA)-approved opioid formulations available on the market in that it offers two benefits concurrently: a prolonged duration of action, and multimodal analgesia through a combination of an opioid (oxycodone) with a nonopioid component. Current FDA-approved combination analgesics, such as Percocet (oxycodone/acetaminophen), are available solely in immediate-release (IR) formulations.
ABSTRACT. Acutepain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness, and necessary medical proce- dures. It is associated with increased anxiety, avoidance, somatic symptoms, and increased parent distress. De- spite the magnitude of effects that acutepain can have on a child, it is often inadequately assessed and treated. Numerous myths, insufficient knowledge among care- givers, and inadequate application of knowledge contrib- ute to the lack of effective management. The pediatric acutepain experience involves the interaction of physi- ologic, psychologic, behavioral, developmental, and sit- uational factors. Pain is an inherently subjective multi- factorial experience and should be assessed and treated as such. Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and tech- niques, anticipate painful experiences and intervene ac- cordingly, use a multimodal approach to pain manage- ment, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.
A Review of the Acute Pain Service in Hospital Kuala Lumpur ORIGINAL ARTICLE A Review of the Acute Pain Service in Hospital Kuala Lumpur G Neelima, MAnaes*, D C Chieng, BMedSc*, T A Linl, FRCA*, K Inb[.]
Cochrane Reviews on TENS for specific types of acutepain have been inconclusive for labour pain (Dowswell 2009) and dysmen- orrhoea (Proctor 2002). An early systematic review of TENS for post-operative pain found TENS to be no better than controls for postoperative pain (Carroll 1996) although pain measures were taken when patients were allowed free access to analgesic medi- cation. This compromises pain scores because patients in placebo and TENS groups titrate analgesic medication to achieve effective pain relief, and therefore exhibit similar pain scores. Review au- thors also included trials that underdosed TENS or used an in- appropriate TENS technique, or both. A meta-analysis with sub- group analysis demonstrated a significantly better outcome for TENS when applied using adequate (optimal) stimulation tech- niques when compared to non-adequate stimulation techniques (Bjordal 2003); optimal TENS techniques were defined as an in- tensity that was strong enough to generate a strong paraesthesia and electrodes applied at the site of the operative scar. Recent ev- idence from systematic reviews suggests that TENS is superior to placebo TENS when used in combination with analgesic medi- cation for thoracotomy and post-sternotomy pain (Freynet 2010; Sbruzzi 2012). To date, there has been no all-encompassing sys- tematic review on TENS for acutepain. A systematic review, which takes account of adequate TENS techniques, is necessary to assist clinicians and researchers to make informed decisions on the effec- tiveness of this modality for acutepain. TENS can be given either as a sole treatment, i.e. stand alone treatment, or combined with other interventions. This Cochrane Review will focus on TENS
Abstract: The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatric anesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postopera- tive analgesia. These modalities are best utilized when combined as a multimodal approach to treat acutepain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acutepain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal.
We used a validated comprehensive QST protocol but did not find signs of generalized hypersensitivity in our patients before or after the operation that could otherwise have indi- cated generalized central sensitization. Preoperative central sensitization has been suggested as a cause for increased acute and chronic postoperative pain, and postoperative central sensitization, triggered by the surgical injury, has been suggested as pathophysiological mechanism for chronic postsurgical pain. Our results, however, are compatible with previous results from two cross-sectional studies that also investigated the patients with PTPS. 22,23 They found signs of
Overall, methoxyflurane provides good procedural anal- gesia with the ease and control of self-administration by the patient. This contrasts with the administration of IV sedation and narcotic analgesia, which requires greater staff involve- ment for administration and monitoring and longer time to discharge, although this must be balanced against the likely greater degree of pain relief provided for very painful proce- dures such as bone marrow biopsy. Nevertheless, satisfaction with methoxyflurane was reported as high among patients undergoing medical procedures in the studies summarized, with many stating that they would be happy to undergo the procedure again if methoxyflurane were used (Table 4). 45,47,50
The current study has some limitations, which include the cross-sectional design, the lack of validated questions of the survey and a possible recall bias. We acknowledge that pain was only measured by a conventional pain scale. Owing to the multifactorial nature of this symp- tom, a thorough assessment would require the evalu- ation of a broad range of factors, which include physical, social and school activities, psychological aspects, socio- cultural contexts, family and peer interactions, cognitive functioning, emotional distress, mood, behavior, and pain-coping strategies . Still, the tool for pain meas- urement used in the study was selected and agreed upon by all participating investigators. We know and under- stand that any instrument used to measure pain can be criticized. However, because to used tool is well vali- dated and widely used in the literature, we are confident that the results of pain assessment in our study are reli- able and valid. The main strengths of our analysis are the high number of participants and their homogeneous distribution across Italy, which make the results of the survey on pain management generalizable to the Italian population of family pediatricians.
From the synthesis of these different ways of assessing patient pain, a theme was revealed related to the lack of robust protocols and standard procedures for pain assessment. Instead this research found that the nursing staff typically did not report using only a single tool for assessing pain in postoperative patients, but rather, tended to use different methods. These different methods form a series of checks and techniques for pain assessment against both verbalised and non-verbalised parameters such facial expression, pulse rate, ability to ambulate or to move around, and even to sleep peacefully. Herr et al. (2006) for example recommend utilising a hierarchy of pain assessment techniques rather than focusing on single objective assessment strategies. In looking at the different aspects of pain assessment Herr recommended that a pain assessment hierarchy, establishing a formal standard operating procedure for pain assessment, minimising the emphasis on physiologic indicators, and reassessing and documenting pain assessment can help to ensure that pain assessments are thorough and consistent. This standard system for pain assessment was not referenced by the nurses in the Kuwaiti hospital and may something which is limiting the autonomy of the nurses and causing some patients to feel that throughout assessments are not being conducted. If the nurses apply a consistent approach to all patients then they may feel more empowered in the pain assessment and pain treatment process, and may also develop a more trusting and communicative relationship with the patient.
Gauze packs were used for anterior nasal packing in both groups. Gauze packs are believed to reduce the risk of postoperative complications such as bleeding, haematomas, and nasal adhesions. Though there is not enough evidence displaying clear advantage of gauze packs after septoplasty . On the contrary, postoperative packing caused discomfort, pain, infectious complications and stuffiness in nose which may have worsened concomitant disorders such as .obstructive sleep apnea. There is additional potential risk of pack displacement and aspiration. In randomized trial trans-septal suturing was compared versus nasal packing. Patients with trans-septal suturing suffered less postoperative complications including pain and discomfort . Furthermore, systematic review of 7 randomised controlled trials with the participation of 869 patients where trans- septal suturing was compared to nasal packing showed nasal ache and headache were significantly less in trans-septal suturing case while postoperative complications including bleeding, haematoma, nasal adhesion, septal perforation and local infectious complications had no intergroup differences . Having regard to these data it might be concluded that trans-septal suturing allowed to avoid the need for nasal packing after septoplasty and hence to avoid nasal pain, discomfort and other risks of nasal packing . We didn’t observe any complications during 3 days nasal packing. But it cannot be excluded that intensity of pain was connected to nasal packing.
Electrical pain was induced with a computer interfaced current stimulator (CICS, Leiden University Medical Center, Leiden, The Netherlands). 13 The stimuli were applied to the skin overlying the left shinbone, through two surface electrodes (electrode surface area 0.8 cm 2 ; space between the electrodes 2 cm). For detection of Pth and Ptol, an escalating current (5-s trains of 200 ms pulses at 10 Hz) was given from 0 to 128 mA at a rate of 0.5 mA/s, during which the subjects indicated their Pth and Ptol by flipping a switch. This process was repeated at least 3 times to obtain an average value ± 0.5 mA for both Pth and Ptol.
The impact of neonatal pain on adult neuroanatomy and neurophysiology was tested in an experiment where an inflammatory agent or saline was injected into the hind- paws of newborn rats (days 0–3) . Rats injected with the inflammation-provoking complete Freund’s adjuvant showed pain behaviours post-injection and inflammation that persisted for 5–7 days. Saline-injected rats showed only immediate withdrawal to needle stick, with no addi- tional pain behaviours or inflammation. Horseradish per- oxidase labelling of dorsal horn primary afferents was increased by about 20% in the lower lumbar regions of the injected side in adult rats who had received neonatal inflammatory injections. Staining for calcitonin gene- related peptide was also increased in rats receiving inflammatory injections as newborn pups. Motoneuron labelling was similar in both limbs in both groups of adults. Horseradish peroxidase labelling was also tested in adult rats who had received an inflammatory injection on postnatal day 14. These rats demonstrated no change in neuronal staining. Possible clinical significance from this neonatal inflammation was demonstrated with physiolog- ical testing of mature rats, which revealed long-term behavioural consequences from neonatal pain exposure. Those mature rats that had received neonatal inflammato- ry injections showed an earlier display of the late phase of pain behaviour after formalin injection. Median time to late phase was 30.5 min in neonatally treated rats vs. 37.1 min in untreated rats (p<0.02), suggesting reduced neural inhibition or enhanced neural activation. In addition, adult rats exposed to neonatal pain showed increased dorsal horn neuron firing rates in response to brush and noxious pinch stimuli compared with untreated rats (p<0.05).
Eugenol is extensively used in dentistry as analgesic and anti-inflammatory. Due to its small size and high density of sensory nerves, cornea is one of the most sensitive tissues of the body. Major sensory nerves of the cornea are poly-modal pain nerves, which respond to thermal, mechanical, or chemical stimuli. The aim of this study was to determine effects of the topical eye and intraperitoneal administration of eugenol on acute corneal pain in male rats. In this experimental study, Seventy-two male Wistar rats were randomly divided into 9 groups of 8 as follows: two topical and intraperitoneal control groups that received normal saline via corneal surface and intraperitoneal ways respectively. The positive control group received 3.5 mg/kg morphine. Three groups received eugenol via corneal surface and three groups intraperitoneally at doses of 3, 10, and 30 mg/kg. Forty µl of 5 M sodium chloride was used to induce corneal pain. One hour after drug administration, the number of eye rubbing in 30 seconds was used to measure acute corneal pain. Morphine significantly reduced eye rubbing caused by 5M sodium chloride. Different amounts of topical ocular and intraperitoneal eugenol significantly decreased acute corneal pain. Topical ocular concentration of 10 and intraperitoneal concentration of 30 showed the best analgesic effect. The analgesic effects of eugenol on acutepain of cornea can be considered in future research.
Patients were included if they met the following inclusion criteria:1) diagnosed with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI); 2) Canadian Triage Acuity Scale Score of 2 (indicative of an emergent status and required assessment within 15 minutes of emergency department (ED) triage) ; and 3) able to speak, read and comprehend English. Additionally, eligibility criteria included cardiac chest pain of more than 20 minutes in duration and/or pain described using angina equivalent pain descriptors ( i.e. nausea, vomiting, shortness of breath, dizziness, fatigue, chest tightness, syncope, diaphoresis), and electrocardiogram changes (ST depression or elevation) in one or more leads. Pa- tients were excluded if they were diagnosed with ST-elevation myocardial infarc- tion [STEMI] (emergent-requiring immediate triage and transfer within 2 to 6 hours for reperfusion percutaneous coronary intervention; had recent sternotomy for coronary artery bypass grafting, or valve replacement (as it may confound the acutepain intensity outcome, should they develop persistent post-operative pain); or if they were unable to consent verbally and in writing.
There are some limitations to this study. First, no preopera- tive measures were collected, which would have allowed the examination of baseline levels of pain-related psychological constructs before the acutepain event. Second, results from this study cannot be generalized to minor surgical procedures because all participants in this sample underwent major sur- gery. Third, given that the response rate for this study was 55%, children with higher APSP or higher levels of postop- erative anxiety or pain catastrophizing refused to participate. Fourth, the FDI in the present study was measured using a
researchers emphasize that enteric protozoa, ascariasis, and toxoplasmosis are the most common parasitic dis- eases; however, the global burden of disease is highest in cysticercosis. Therefore, these data indicate that there is no correlation between the incidence of the parasitic dis- ease and the frequency and severity of symptoms . Parasitic diseases may be transmitted in three different ways as (i) fecal-oral route, (ii) active penetration of the skin by larvae, and (iii) vector arthropods . Infestation affects different parts of the body. Nevertheless, abdom- inal involvement is seen in the majority of cases. Al- though the clinical symptoms are usually nonspecific, patients may present with acute abdominal pain due to inflammatory changes in parenchymal organ, bowel walls, bile ducts, and peritoneal surfaces and obstructive changes in bowels and bile ducts. Acute abdominal pain may also result from complications of parasitic involve- ment such as abscess formation and rupture of focal parasitic cystic lesions. A parasite may be hosted by a specific intraabdominal organ, or may travel among sev- eral intraabdominal organs, or may induce a cyst forma- tion that could be complicated with rupture, superinfection, or mass effect. Therefore, clinical and radiological findings may vary for the different types of parasites and also for their site of involvement. The present study aims to raise awareness about abdominal parasitosis that we encountered in our emergency radi- ology practice. A detailed literature search was also