Pain management nursing : official journal of the American Society of Pain Management Nurses
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Randomized Controlled Trial Multicenter Study
The effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis.
Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures and one of the most frequently performed ones, and children and adolescents on hemodialysis are anxious about repeated venipunctures. Distraction is one of the most effective ways to relieve pain, and nurses are responsible for pain control. ⋯ After distraction, pain intensity during venipuncture significantly decreased (p=.003); but this decrease began from the sixth session; at the five first sessions, pain intensity had not changed. This study shows the effect of distraction with a simple, inexpensive, and quick way for decreasing the pain caused by venipuncture. We recommend that the reasons of the intervention's delay in effect be assessed in future studies.
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The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain in older adults create an urgent need to unravel the complexities of chronic pain management in this population. This requires health professionals to understand both normal and pathologic changes that occur within the aging body and mind, as well as how those factors affect responses to pain and pain-relieving treatments. The medical management of pharmacologic treatment for pain in older adults is often suboptimal, ranging from failing to use analgesics for patients with considerable pain to exposing older adults to potentially life-threatening toxicities, overdoses, or drug interactions. ⋯ Older adults tend to be more vulnerable to side effects and drug interactions than their younger counterparts, owing to differences in drug distribution, metabolism, and elimination. This review delineates these vulnerabilities and informs clinicians of the strategies needed to promote safe and effective use of medications to treat pain in older adults. The goal of this paper was to review specific considerations for balancing efficacy and safety in the pharmacologic treatment of persistent pain in older adults.
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Across all care settings for older patients, pain is often ineffectively managed. A gap still exists between best-practice recommendations for pain assessment/treatment and current clinical practice, despite the availability of guidelines. Using a validated pain scale is critical to objectively evaluate pain intensity. ⋯ Pain undertreatment is a particularly important phenomenon to address, because unrelieved persistent pain can significantly affect older individuals. Approaches tailored to an individual's needs and supported by the best available evidence should be implemented to improve patient outcomes and to increase the consistency with which care is delivered to the growing population of older Americans. The goal of this paper was to provide current evidence-based strategies and tools for pain assessment in older adults, including those with cognitive impairment.
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Interference of postoperative pain on women's daily life after early discharge from cardiac surgery.
Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. ⋯ Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important.
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Feasibility and clinical utility are essential characteristics to consider when it comes to developing or selecting a pain assessment tool to implement into practice. However, these characteristics have not been widely studied with available pain assessment tools in critically ill adults. The objective of this study was to describe nurses' evaluations of the feasibility and clinical utility of the Critical-Care Pain Observation Tool (CPOT) in assessing pain in critically ill ventilated adults. ⋯ On the other hand, six nurses mentioned that they were already sensitive to nonverbal cues of pain before the introduction of the CPOT. In conclusion, the CPOT is a valid behavioral pain scale, which has been suggested by experts in recent critical reviews. So far, the CPOT is being used for research purposes and has been implemented into clinical practice of various health care centers of North America.