Pain management nursing : official journal of the American Society of Pain Management Nurses
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Patients often suffer from inadequate treatment of postoperative pain. The purpose of this study was to survey the factors affecting patient satisfaction with postoperative pain management. A questionnaire with 41 items was given on the third postoperative day to 102 patients undergoing major orthopedic or vascular surgery. ⋯ Eighty percent of the patients were satisfied with pain management, and their satisfaction correlated significantly with received preoperative information (p < .01) and preoperative well-being (p < .01). There is discrepancy between the amount of experienced pain and values of the frequent VAS recordings, which does not seem to be due to the nurses' attitudes toward pain. Preoperative interview is important tool to receive and give information concerning postoperative pain management.
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Opioid tolerance and opioid-induced hyperalgesia are conditions that negatively affect pain management. Tolerance is defined as a state of adaptation in which exposure to a drug induces changes that result in a decrease of the drug's effects over time. Opioid-induced hyperalgesia occurs when prolonged administration of opioids results in a paradoxic increase in atypical pain that appears to be unrelated to the original nociceptive stimulus. ⋯ Pain facilitatory mechanisms in the central nervous system are known to contribute to opioid-induced hyperalgesia. Recent research indicates that there may be overlap in the two conditions. This article reviews known and hypothesized pathophysiologic mechanisms surrounding these phenomena and the clinical implications for pain management nurses.
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Methadone treatment in chronic pain patients is still limited owing to misconceptions about addiction, safety, and its unique pharmacokinetic and pharmacodynamic properties. Nevertheless, patients with chronic noncancer pain are frequently treated with methadone at our Pain Centre either as the first opioid of choice, for specific pain conditions, or as a second-line opioid in patients developing tolerance or intractable side effects with other opioids. The aim of this study was to examine whether a nurse case management program of chronic pain patients treated with methadone is feasible and safe in trying to improve patients' care in an ambulatory setting. ⋯ No patients developed serious morbidity or mortality. Fifty-seven percent of patients were either satisfied or very satisfied with their treatment. A nurse-led case management program of methadone in chronic pain patients can improve patient care in an ambulatory setting.