Pain management nursing : official journal of the American Society of Pain Management Nurses
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Increasing interest has focused on complementary management modalities, including tai chi, acupuncture, yoga, and massage therapy, as treatments for osteoarthritis (OA). This review article synthesizes evidence from randomized controlled trials (RCTs) and systematic reviews (SRs) that examined one or more of the above as treatments for OA. Medline, Pubmed, and Cinahl databases were searched to identify English-language articles using an RCT design or that conducted a SR of published studies and presented data on symptom or functional outcomes. ⋯ Limited information exists regarding the relative effectiveness of the therapies (e.g., yoga vs. tai chi vs. acupuncture), as well as treatment effects in persons with joint involvement besides the knee and in distinct patient subgroups (e.g., older vs. younger adults, persons with mild vs. moderate vs. advanced disease). Complementary therapies can reduce pain and improve function in adults with OA. Research is needed to evaluate long-term benefits of the treatments, as well as their relative effects among diverse patient subgroups.
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Chronic noncancer pain (CNCP) is a common and complex disorder associated with declines in physical health and functional status, emotional well-being, and quality of life. To best address the complexity of this condition, research and clinical practice for CNCP should be guided by a framework incorporating both biologic and psychologic factors. This article presents a biobehavioral model of chronic pain that hypothesizes mechanisms related to the effectiveness of a complementary therapy, guided imagery (GI), for this population. ⋯ A biobehavioral approach to nursing phenomena will advance understanding of health and health-related issues and has the potential to improve outcomes through delineation of mechanisms underlying relationships between psychologic and biologic factors. Increased consumer use of complementary therapies to treat pain, the current cost-driven health care system, and the mandate for evidence-based practice support the need to validate the efficacy of such therapies. This empirically derived model provides a framework for practice and research for nurses and other health care providers to promote health, function, and well-being in persons with CNCP.
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Review Case Reports
Management of the hospitalized patient experiencing acute on chronic pain: a case study.
The ability to balance the patient's level of comfort while minimizing adverse outcomes related to overdosing remains the key to providing excellent post operative care for the patient with chronic pain. This article presents the case of a hospitalized patient with severe pain and the challenges her care presented to the nursing staff.
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Persistent pain is a costly epidemic, affecting >50 million Americans with estimated expenditures of >$200 billion annually for direct care and lost productivity. Recent advances in epigenetic/genomic understanding of pain and analgesic response may lead to improvements in pain management and help curtail costs by providing more precise detection of the pain mechanisms involved and thereby more personalized and effective treatments. However, the translation of epigenetic and genomic strategies for pain management into clinical practice will depend on understanding their potential applications. ⋯ The initial discussion focuses on present understanding of nociceptive pathways and alterations that lead to pathologic pain. The discussion then moves to a review of epigenetic mechanisms that have been identified in the transition to and maintenance of persistent pain as well as in the individual's response to analgesics. Potential applications of epigenetics/genomics to identify people at risk and possibly prevent persistent pain and guide diagnosis and the selection of therapeutic modalities are presented.