Pain medicine : the official journal of the American Academy of Pain Medicine
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Despite new guidelines and nationally mandated regular assessments, managing pain in cognitively impaired patients remains a complex and challenging task. Numerous studies have focused on assessing pain in this population; however, studies of treatment are limited. ⋯ Current assessment and treatment practices in acute pain management for cognitively impaired patients vary widely (to include service and provider type). Implementation of evidence-based guidelines is needed to improve patient care.
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To investigate the efficacy, safety, and impact on quality of life of long-term administration of OROS hydromorphone ER (8-128mg) in patients with chronic low back pain. ⋯ The results support the long-term use of OROS hydromorphone ER in managing chronic moderate to severe low back pain.
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Although cancer pain (consistent and breakthrough pain [BTP; pain flares interrupting well-controlled baseline pain]) is common among cancer patients, its characteristics, etiology, and impact on health-related quality of life (HRQOL) across the lifespan are poorly understood. ⋯ These data provide evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike but demonstrate an increased toll for younger adults (especially financially). Beyond race and gender disparities, further health care disparities in the cancer and cancer pain were identified by age, illustrating the need for additional research across the lifespan in diverse cancer survivors.
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Case Reports
Continuous transversus abdominis plane (TAP) block catheters in a combat surgical environment.
The ongoing conflict in Afghanistan continues to generate a large number of complex trauma injuries and provides unique challenges to military anesthetists working in forward field hospitals. We report successful use of ultrasound-guided continuous transversus abdominis plane (TAP) block in two Afghan war casualties who sustained major trauma with coagulopathy. The use of bilateral continuous TAP blocks following major thoracoabdominal trauma in a combat environment is unique in the literature. ⋯ A continuous TAP block technique can be utilized to provide excellent analgesia following major abdominal surgery when neuraxial anesthesia is contraindicated. The TAP block's ease of placement under ultrasound guidance makes this technique particularly useful in the austere battlefield hospital environment.