Pain management nursing : official journal of the American Society of Pain Management Nurses
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Randomized Controlled Trial
Nondrug therapies for pain management among rural older adults.
This quasiexperimental two-group pilot study tested an intervention aimed at educating older adults in rural communities about the appropriate use of nondrug treatments for pain. Earlier data reveal that older adults use significantly less nonpharmacologic modalities than their younger counterparts, and that pain self-treatment is prevalent in rural areas. Individuals aged ≥60 years who experienced pain in the preceding 2 weeks were recruited from rural Midwestern communities through the use of flyers and information sessions at hospitals, churches, and community organizations. ⋯ Hot and cold packs and relaxation breathing instruction were provided for use over the 2-week period. There was a significant increase in the use of all nondrug treatments and a decrease in pain-related distress and current pain scores in the experimental group compared with the control group. This study informs nurses and other health care providers on the value of education for use of nondrug therapies in conjunction with pharmacologic pain management among rural older adults.
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The American Society for Pain Management Nursing (ASPMN) has developed a position statement and clinical practice recommendations related to procedural preparation and comfort management. Procedures potentially produce pain and anxiety, both of which should be assessed and addressed before the procedure begins. This position statement refers to "comfort management" as incorporating the management of pain, anxiety, and any other discomforts that may occur with procedures. ⋯ Furthermore, ASPMN does not condone procedures being performed without the implementation of planned comfort assessment and management. In addition to outlining this position with supporting evidence, this paper reviews the ethical considerations regarding procedural comfort management and provides recommendations for nonpharmacologic and pharmacologic management during all phases of the procedure. An appendix provides a summary of this position statement and clinical practice recommendations.
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A significant proportion of patients report long-term pain that is ≥5 on a 0-10 intensity scale after limb-sparing surgery for malignancies of the long bones. Patients experience several distinct types of pain after limb-sparing surgery which constitute a complex clinical entity. This retrospective study examined 26 years of experience in a pediatric institution (1981-2007) in pain management as long as 6 months after limb-sparing surgery and reviewed the historical evolution of pain interventions. ⋯ Therapies included opioids, nonsteroidal antiinflammatory drugs, acetaminophen-opioid combinations, postoperative continuous epidural infusion, anticonvulsants and tricyclic antidepressants for neuropathic pain, local anesthetic wound catheters, and continuous peripheral nerve block catheters. Management of pain after limb-sparing surgery has evolved over the 26 years of this review. It currently relies on multiple "layers" of pharmacologic and nonpharmacologic strategies to address the complex mixed nociceptive and neuropathic mechanisms of pain in this patient population.