AACN clinical issues
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AACN clinical issues · Jul 2005
Randomized Controlled Trial Clinical TrialSkin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick.
The purpose of the study was to compare a heel stick conducted during Kangaroo Care (skin-to-skin contact) with the mother to a heel stick in a warmer in reducing premature infant physiologic and behavioral pain responses. Twenty-four premature infants in a university-based neonatal intensive care unit were recruited and randomized to 2 sequences: sequence A group received 3 hours of Kangaroo Care (with a heel stick in Kangaroo Care) followed by 3 hours in a warmer (with a heel stick in the warmer). Sequence B group had warmer care and a heel stick (in the warmer) before Kangaroo Care and a heel stick (in Kangaroo Care). ⋯ Heart rate and length of crying in response to pain were significantly reduced during Kangaroo Care and the Kangaroo Care heel stick as compared to when infants were in the warmer and had a heel stick in the warmer. Three infants did not cry at all during the Kangaroo Care heel stick; infants slept more during Kangaroo Care than in the warmer. Kangaroo Care positioning before and during heel stick is a simple and inexpensive analgesic intervention to ameliorate pain in stable premature infants.
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The endogenous opioid system is one of the most studied innate pain-relieving systems. This system consists of widely scattered neurons that produce three opioids: beta-endorphin, the met- and leu-enkephalins, and the dynorphins. These opioids act as neurotransmitters and neuromodulators at three major classes of receptors, termed mu, delta, and kappa, and produce analgesia. ⋯ This article examines some of the recent findings about the opioid system, including interactions with other neurotransmitters, the location and existence of receptor subtypes, and how this information drives the search for better analgesics. We also consider how an understanding of the opioid system affects clinical responses to opiate administration and what the future may hold for improved pain relief. The goal of this article is to assist clinicians to develop pharmacological interventions that better meet their patient's analgesic needs.
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AACN clinical issues · Jul 2005
Review Case ReportsComplex pain consultations in the pediatric intensive care unit.
The assessment and management of pain in children is not always easy and it is clearly more difficult in the critical care setting. Pain management is further complicated in this vulnerable population by the nature of their critical condition, the complexity and multidimensionality of their illness or injuries, and the intensity of emotions in this environment. A variety of pain syndromes are encountered in the pediatric intensive care unit, and the staff there may not be familiar with or comfortable managing these cases. Pain assessment and treatment can be more appropriately managed when guided by the experts of a multidisciplinary pediatric pain service.
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AACN clinical issues · Jul 2005
ReviewOrofacial pain--Part I: Assessment and management of musculoskeletal and neuropathic causes.
Orofacial pain is a common complaint, affecting the lives of millions of people around the world. Chronic orofacial pain often constitutes a challenging diagnostic problem that can be complicated by psychosocial factors and typically requires multidisciplinary treatment approaches. The fundamental prerequisite for successful management of orofacial pain is an accurate diagnosis. ⋯ This article presents the salient clinical features and the therapeutic approaches for the various subtypes of musculoskeletal and neuropathic pain. Musculoskeletal pain is the most prevalent orofacial pain, with temporomandibular disorders and tension-type headache being the main examples. Neuropathic pain develops secondary to neural injury and/or irritation and can be distinguished into episodic, including trigeminal neuralgia and glossopharyngeal neuralgia, as well as continuous, such as herpetic and postherpetic neuralgia, traumatic neuralgia, and Eagle's syndrome.
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AACN clinical issues · Jul 2005
ReviewAcute musculoskeletal pain in the emergency department: a review of the literature and implications for the advanced practice nurse.
Acute pain assessment and management and their accurate documentation have been identified by The Joint Commission on the Accreditation of Healthcare Organization as significant components of the emergency department experience. Research studies have historically focused on the subjective perception of the physician or nurse for evidence of acute musculoskeletal pain assessment for the patient; however, the lack of interrater reliability between caregivers and patients has illustrated the need to evaluate the patient's perception of pain. ⋯ The purpose of this article is to review pain management practices for patients with acute musculoskeletal pain who present to the emergency department and to provide recommendations for advanced practice nurses working with this emergency department patient population. Promising areas for future research include targeting mechanisms of pain with specific medications, identifying vulnerable populations at risk for inadequate pain management, and universal use of a standardized pain rating scale.