Pain management nursing : official journal of the American Society of Pain Management Nurses
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Black older adults often experience disparities in pain treatment that results in unmet pain needs. The aims of this study were to assess the pain management experiences of a group of community dwelling Black older adults and identify gaps in clinical practice. A qualitative, descriptive design was employed using the methodology of ethnography. ⋯ Qualitative interviews revealed that pain management barriers were centered around communication concerns about side effects, fears of addiction, and provider mistrust. A communication gap exists between patients and providers. Discussing patient treatment preferences, providing balanced treatment information, and following-up with patients on treatment plan effectiveness by phone can improve how pain is managed for Black older adults.
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Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. Although nurses have an ethical obligation to reduce suffering, barriers remain regarding appropriate and adequate pain management at the end of life. This joint position statement from the American Society for Pain Management Nursing and Hospice and Palliative Nurses Association contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population.
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Meta Analysis
The Effects of Massage Therapy on Pain and Anxiety after Surgery: A Systematic Review and Meta-Analysis.
Pain management is critical for patients after surgery, but current pain management methods are not always adequate. Massage therapy may be a therapeutic complementary therapy for pain. Many researchers have investigated the effects of massage therapy on post-operative pain, but there have been no systematic reviews and meta-analysis of its efficacy for post-operative patients. ⋯ The effect of single dosage massage therapy on post-operative pain showed significant improvement (-0.49; 95% confidence intervals -0.64, -0.34; p < .00001) and low heterogeneity (p = .39, I2 = 4%), sternal incisions showed significant improvement in pain (-0.68; -0.91, -0.46; p< .00001) and low heterogeneity (p = .76, I2 = 0%). The anxiety subgroups showed substantial heterogeneity. The findings of this study revealed that massage therapy may alleviate post-operative pain, although there are limits on generalization of these findings due to low methodological quality in the reviewed studies.
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An old anesthetic agent, ketamine is finding new use in lower doses for analgesic purposes. There are concerns stemming from its potential side effects-specifically psychomimetic effects. These side effects are directly related to dose amount. ⋯ The literature supports the use of ketamine for analgesic purposes, and ketamine offers a nonopioid option for the management of some pain conditions. Because ketamine is still classified as an anesthetic agent, health care institutions should develop their own set of policies and protocols for the administration of ketamine. By using forethought and understanding of the properties of ketamine, appropriate care may be planned to mitigate potential side effects and adverse events so that patients are appropriately cared for and their pain effectively managed.
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Randomized Controlled Trial
Management of Sickle Cell Pain Using Pregabalin: A Pilot Study.
Sickle cell disease (SCD) pain may have a neuropathic component. Adjuvant drugs used to treat neuropathic pain have not been studied for the treatment of adults with SCD. To determine the safety and feasibility of using pregabalin for chronic SCD pain. ⋯ Mean quality-of-life scores increased slightly over time (representing better quality of life) in 7 of 8 domains for the pregabalin group and decreased in 4 of 8 domains for the placebo control group. Small sample size made it difficult to interpret quality-of-life findings. This pilot study provided sufficient evidence that further investigation of pregabalin's potential efficacy for treatment of chronic SCD pain in adults is warranted.