Pain management nursing : official journal of the American Society of Pain Management Nurses
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Review Case Reports
The role of intravenous acetaminophen in acute pain management: a case-illustrated review.
For more than a century, acetaminophen has been recognized worldwide as a safe and effective agent for relieving pain and reducing fever in a wide range of patients. However, until recently, acetaminophen was available in the United States only in oral and rectal suppository formulations. In November 2010, the United States Food and Drug Administration granted approval for the use of a new intravenous (IV) formulation of acetaminophen for: 1) the management of mild to moderate pain; 2) the management of moderate to severe pain with adjunctive opioid analgesics; and 3) the reduction of fever in adults and children (age ≥ 2 years). This case-illustrated review of IV acetaminophen begins with a discussion of the rationale for the drug's development and proceeds to analyze the clinical pharmacology, efficacy, safety, and nursing implications of its use, both as monotherapy and in combination with other agents as part of a multimodal pain therapy strategy.
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Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. ⋯ Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.
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This research assessed: 1) whether patients thought to have sleep disordered breathing would have more severe symptoms if they were taking opioids; 2) whether severity of sleep disordered breathing was associated with class or dose of opioid; and 3) whether pain intensity was associated with sleep disordered breathing. A descriptive cross-sectional study of patients referred for assessment of sleep disorders was conducted. Data were collected on a total of 419 subjects (no pain [n = 171], chronic pain without opioid treatment [n = 187], and chronic pain with opioid treatment [n = 61]). ⋯ Patients with chronic pain taking opioids had a mean of 5 ± 13 central apneic events per hour compared with 1.6 ± 7 events per hour in patients without pain and not taking opioids. Oxygen saturation mean nadir 83.5% (opioid group) versus 82.9% (no pain, pain without opioid) was not significantly different. The clinical relevance of the effect is unknown, so the potential for marginal respiratory disturbance (an increase of 2.8 central events per hour for every 100 mg morphine-equivalent opioid dose) must be weighed against the therapeutic value of pain management with opioids.
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Review Case Reports
Spinal cord stimulation to treat postthoracotomy neuralgia: non-small-cell lung cancer: a case report.
Surgery is the mainstay of therapy for resectable-type tumors associated with non-small-cell lung cancer. Today, thoracotomy and video-assisted thoracotomy are surgical options. The prevalence of chronic pain with neuropathic symptoms is relatively high after thoracotomy. ⋯ This detailed case presentation provides a qualitatively weighted investigation into spinal cord stimulation for postthoracotomy neuralgia against the backdrop of oncologic care. Further investigations relying on quantitative assessment tools are necessary to further explore this form of therapy in this patient population. In the single case reported here, the use of spinal cord stimulation suppressed intractable pain targeted at the T6 and T7 dermatomes of the chest wall in the manifestation of postthoracotomy neuralgia.
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First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. ⋯ The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.