Pain management nursing : official journal of the American Society of Pain Management Nurses
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Multicenter Study Observational Study
The Credibility of Self-reported Pain Among Institutional Older People with Different Degrees of Cognitive Function in Taiwan.
Despite many studies conducted to validate the self-reported pain of vulnerable patients, it is unclear at what level of cognitive impairment individuals still can provide reliable information. The aims of this study were to examine the reliability and validity of self-reported pain by degree of patients' cognitive function and to determine important predictors of self-reported pain in cognitively impaired residents in long-term care facilities. The 414 participants were divided into four groups according to their scores on the Mini-Mental State Examination (nonimpaired, mild, moderate, and severe cognitive impairment). ⋯ Regression analyses revealed that multiple pain indicators together were significantly better predictors of self-reported pain in moderately and severely impaired residents. The findings from this study support residents with cognitive impairment up to a moderate level can report pain reliably. However, for those in later stages of dementia, a multifaceted approach is suggested to help in pain recognition.
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Randomized Controlled Trial Comparative Study
Comparison of the efficacy and safety of different doses of propacetamol for postoperative pain control after breast surgery.
Intravenous propacetamol has been shown to be effective for postoperative pain control. However, the recommendations regarding propacetamol doses for pain control are vague. The present study was performed to compare the efficacy and safety of propacetamol at a dose of 1 g or 2 g. ⋯ There were no differences in efficacy variables, including visual analog scale, the 4-point categorical scale, and requests for rescue analgesia, between propacetamol doses of 1 g and 2 g. Adverse events were similar in the two groups. Intravenous propacetamol at a dose of 2 g is not superior to the lower dose of 1 g with regard to postoperative analgesia or the incidence of side effects in breast-conserving surgery.
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Obstructive sleep apnea (OSA) is a chronic breathing disorder that contributes to many other health problems (Epstein et al., 2009). It is present but undiagnosed in a large percentage of the population (Adesanya, Lee, Grilich, & Joshi, 2010). Pain is recognized as a public health problem in the United States, affecting millions of people of all ages (Committee on Advancing Pain Research, Care, and Education Board on Health Sciences Policy, 2011). ⋯ Opioid analgesics used to treat pain may cause sedation and respiratory depression by themselves. When administered to individuals with OSA, the risk for harmful respiratory events increases. This article reviews the assessment and monitoring needed to administer opioids safely to individuals with OSA and identifies best practices from a review of the literature.
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Nonprofessional caregivers frequently experience barriers to using analgesics for pain in patients in home hospice settings, and patients in pain may suffer needlessly. For example, caregiver adherence to the administration of analgesics is lower for as-needed (PRN) regimens than for standard around-the-clock regimens. But little is known about the barriers caregivers experience and the effects of those barriers. ⋯ Caregivers adhered to PRN analgesic regimens approximately 51% of the time. Higher caregiver adherence to PRN analgesic regimens was associated with lower patient pain intensity and higher patient QoL, but not, surprisingly, with barriers to pain management. Longitudinal studies are now needed to identify factors besides caregiver barriers that may unduly lower caregiver adherence to PRN analgesic regimens.
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Pain following cardiac intervention in children is a common, but complex phenomenon. Identifying and reporting pain is the responsibility of the nursing staff, who are the primary caregivers and spend the most time with the patients. Inadequately managed pain in children may lead to multiple short- and long-term adverse effects. ⋯ In first (asymptomatic) and second (symptomatic) case scenarios, 78.6% and 59.5% underestimated pain, respectively. Knowledge and attitudes regarding pain and its management is poor among nurses. Targeted training sessions and repeated reinforcement sessions are essential for holistic patient care.