Pain physician
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Randomized Controlled Trial
Efficacy and safety of dexmedetomidine added to caudal bupivacaine in pediatric major abdominal cancer surgery.
Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective alpha-2 agonist with sedative and analgesic properties. ⋯ Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.
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Observational Study
Effect of a fixed-dose opioid agonist/antagonist on constipation in patients on long-term opioids for non-malignant pain unable to tolerate laxatives.
Chronic pain affects a large number of patients throughout the world and impacts greatly on their quality of life, including the ability of a patient to sleep, go to work, and socialize. Guidance on the use of opioids in chronic pain patients is available from the British Pain Society; however, patients receiving opioid treatment for their pain often suffer from symptoms associated with opioid-induced bowel dysfunction (OIBD), including constipation. The usual treatment of constipation in these patients is laxatives; however, one study has shown that 54% of patients do not receive the desired results from this approach. Oxycodone/naloxone tablets have been shown to provide analgesia to chronic pain patients, while improving the symptoms of OIBD, as the naloxone component blocks the effects of oxycodone at opioid receptors in the gut. ⋯ The results of this study indicate that patients receiving oxycodone/naloxone tablets achieved statistically and clinically significant improvements in bowel function as well as quality of life after 12 weeks of treatment.
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Comparative Study
Patient perception of pain care in the United States: a 5-year comparative analysis of hospital consumer assessment of health care providers and systems.
The necessity of aggressive pain management in the hospital setting is becoming increasingly evident. It has been shown to improve patient outcomes, and is now an avenue for Medicare to assess reimbursement. In this cohort analysis, we compared the March 2008 to the December 2012 Hospital Consumer Assessment of Health Plans Survey (HCAHPS) reports in order to determine if pain management has improved in the United States after this national standardized survey was created. ⋯ The HCAHPS survey is a national public standardized report used as a way to compare care in the United States. Patient pain perception has improved between the 2008 and 2012 reports. Further studies are needed to evaluate critical care hospitals.
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Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers should consider diagnosing ACNES once a patient has both a positive result from a Carnett's test and precise localization of pain. ⋯ Chronic pain can lead to significant emotional and social impacts on these pediatric patients, as well as their on their families. Further, the extensive utilization of health care resources is impacted when children with undiagnosed ACNES undergo invasive treatments when ACNES is not in the early differential. The purpose of this case series report is to prompt better recognition of the condition ACNES, and to highlight the efficacy of TAP blocks as a management strategy.
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The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists. ⋯ Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain.