Articles: pain-management-methods.
-
The University of Washington instituted a policy requiring all credentialed clinicians who prescribe opioids to complete a one-time education activity about safe and responsible opioid prescribing. A scenario-based, interactive online learning module was developed for opioid management of acute pain in hospitalized adults. This study examined the impact of the education module on learners' knowledge, perceived competence, and use of guideline-adherent practices. ⋯ Our findings suggest that this online education module about safe opioid prescribing for acute pain management was effective at improving knowledge, increasing the likelihood of using guideline-adherent clinical practices, and increasing perceived competence.
-
Spinal cord stimulation (SCS) for pain is typically implemented in an open-loop manner using parameters that remain largely unchanged. To improve the overall efficacy and consistency of SCS, one closed-loop approach proposes to use evoked compound action potentials (ECAPs) recorded from the SCS lead(s) as a feedback control signal to guide parameter selection. The goal of this study was to use a computational modeling approach to investigate the source of these ECAP recordings and technical and physiological factors that affect their composition. ⋯ Our modeling results suggest that clinically effective SCS relies on the activation of numerous axons within a narrow fiber diameter range and that several factors affect the composition of the ECAP recordings. These results can improve how we interpret and implement these recordings in a potential closed-loop approach to SCS.
-
Randomized Controlled Trial
Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial.
Primary care providers are frequently unprepared to manage chronic pain adequately due in part to insufficient professional training. This study evaluated the effect of a telementoring intervention on knowledge and perceived competence related to chronic pain management. ⋯ Further research is recommended to establish the effectiveness of this telementoring intervention.
-
Acute postoperative pain is common. Nearly 20 per cent of patients experience severe pain in the first 24 h after surgery, a figure that has remained largely unchanged in the past 30 years. This review aims to present key considerations for postoperative pain management. ⋯ Adequate perioperative pain management is integral to patient care and outcomes. Each of the biological, psychological and social dimensions of the pain experience should be considered and understood in order to provide optimum pain management in the postoperative setting.
-
The endocannabinoid system (ECS) is known to modulate not only food intake but also pain, especially via the cannabinoid type 1 receptor (CB1R) expressed throughout the central nervous system and the peripheral tissues. Our previous study demonstrated that fasting produces an analgesic effect in adult male mice, which is reversed by intraperitoneal (i.p.) administration of CB1R antagonist (SR 141716). In the present study, we further examined the effect of CB1R expressed in the peripheral tissues. ⋯ The formalin-induced c-Fos expression at the spinal cord level was not affected by fasting, and in vivo recording from the superficial dorsal horn of the lumbar spinal cord revealed that fasting did not affect formalin-induced neural activity, which indicates minimal involvement of the spinal cord in fasting-induced analgesia. Finally, when we performed subdiaphragmatic vagotomy to block the hunger signal from the gastrointestinal (GI) system, AM 6545 did not affect fasting-induced analgesia, but SR 141716 still reversed fasting-induced analgesia. Taken together, our results suggest that both peripheral and central CB1Rs contribute to fasting-induced analgesic effects and the CB1Rs in the GI system which transmit fasting signals to the brain, rather than those in the peripheral sensory neurons, may contribute to fasting-induced analgesic effects.