European journal of pain : EJP
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This synopsis outlines factors that prompted development of national clinical practice guidelines for the management of pain and presents the essential content of major pain control guidelines. Also described is the concurrent growth of the evidence-based pain management movement worldwide in the decade since initial US federal guidelines on acute and cancer pain were developed, and products of this global movement. ⋯ This survey will highlight recent research that evidence-based guidelines alone are insufficient to overcome established attitudes, practices and myths that hinder pain assessment and management. Hypotheses for the inadequacy of scientific evidence per se to overcome clinicians' attitudes and practices will be advanced, along with suggestions as to how those in the 'pain treatment community' may help to tip the balance.
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Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). ⋯ Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non-cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.
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Experience of moderate or even severe postoperative pain has remained a clinical problem despite major progress in pain assessment and management. The aim of the present study was to assess any association between different pre- as well as postoperative factors, actual pain experiences in the postoperative period, and the overall patient satisfaction with the pain management. A random sample of surgical patients (n =191) responded to pre- and postoperative questionnaires detailing presence of preoperative baseline pain, expected and actually experienced postoperative pain levels and perceived adequacy of the pain relief provided. ⋯ Main characteristics of the dissatisfied patient were a younger age and female sex. It is concluded that patients commonly expect moderate to severe pain in the postoperative period and that the actual pain experience is mainly in accordance with the pre-operative expectations. Therefore, the validity of patient satisfaction as an optimal outcome variable in quality assurance processes of postoperative pain management may be questioned.
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The World Health Organization document Cancer Pain Relief and Palliative Care in Children (WHO, 1998) advocates the global application of the principles of pain management and palliative care for children with cancer. The principles of pain management include the application of the WHO analgesic ladder, appropriate opioid dose escalation, the use of adjuvant analgesics, and the use of non-pharmacological methods of pain control. These principles of pain management should be incorporated into the treatment protocols of all children with cancer, acknowledging that treatment options may be limited for some children.
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Comparative Study
The management of chronic pain in Switzerland: a comparative survey of Swiss medical specialists treating chronic pain.
Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed. Management of all types of chronic pain by pain clinic practitioners and rheumatologists, oncologists or neurologists was compared via a mailed questionnaire survey (n=125/group). Two hundred and twenty-nine (46%) of 500 mailed questionnaires were returned with similar group return rates. ⋯ Pain clinic practitioners and oncologists bring particular-differing-skills to chronic pain management compared to rheumatologists and neurologists. Chronic pain management diversity may result from differences in malignant and benign pain, and its generally being provided by the speciality treating the underlying cause. This survey identifies targets for improvement in areas fundamental to good chronic pain practice: interdisciplinarity, diagnostic/therapeutic tools, quality management and education.