Articles: pain-management-methods.
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Case Reports
Salvage Therapy With Burst Spinal Cord Stimulation for Chronic Pancreatitis: A Case Report.
Pain associated with chronic pancreatitis is often difficult to treat. On many occasions, interventional techniques may be necessary. In recent years, spinal cord stimulation techniques have been used successfully in the treatment of these patients. However, only the use of traditional tonic stimulation based on paresthesias has been published for this purpose. Spinal cord burst stimulation has been shown to be more effective than tonic stimulation, especially in failed back surgery syndrome. ⋯ A sustained pain score reduction of over 50% on the visual analogue scale was seen, as were a decrease in opioid consumption and a high degree of satisfaction with the therapy by our patient.
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The increase in opioid-related deaths in the United States (and other countries) has prompted a national debate in medicine about the appropriateness of opioids for the treatment of acute and chronic pain, and specifically in children, if medical opioid use causes or increases the risk of opioid use disorder (OUD) later in life. Some in the medical community and in government advocate withholding opioids from children after an arbitrary number of days of treatment, regardless of diagnosis. Here, I argue that opioid experimentation and misuse is no more common in children and adolescents today than 2 or 3 decades ago, that there is no compelling evidence that appropriate medical use of opioids leads to OUD, and that the epidemic of inadequately treated pain in children remains the more compelling issue.
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Critical care nurse · Jun 2019
ReviewUsing Valid and Reliable Tools for Pain and Sedation Assessment in Pediatric Patients.
Pain management and sedation strategies have become more complex in recent years, with accompanying documented increases in morbidity and mortality. Consequently, various government agencies and professional associations have issued requirements or recommendations designed to ensure optimal and safe pain management in different populations. The pediatric nurse must understand the rationale behind these guidelines, which pain and sedation assessment tools are valid and reliable, how and when to use these tools, and the purpose and limitations of each tool. This article summarizes the recent recommendations, identifies valid and reliable pediatric pain and sedation assessment tools, and describes the appropriate use of these tools to provide safe and high-quality patient care.
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Anesthesia and analgesia · Jun 2019
Randomized Controlled TrialVirtual Reality Analgesia in Labor: The VRAIL Pilot Study-A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women.
This pilot study investigated the use of virtual reality (VR) in laboring women. Twenty-seven women were observed for equivalent time during unmedicated contractions in the first stage of labor both with and without VR (order balanced and randomized). ⋯ Significant decreases in sensory pain -1.5 (95% CI, -0.8 to -2.2), affective pain -2.5 (95% CI, -1.6 to -3.3), cognitive pain -3.1 (95% CI, -2.4 to -3.8), and anxiety -1.5 (95% CI, -0.8 to -2.3) were observed during VR. Results suggest that VR is a potentially effective technique for improving pain and anxiety during labor.
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Multicenter Study Observational Study
Paediatric procedural sedation and analgesia by emergency physicians in a country with a recent establishment of emergency medicine.
Paediatric patients receive less procedural sedation and analgesia (PSA) in the emergency department compared with adults, especially in countries where emergency medicine is at an early stage of development. The objectives of this study were to evaluate the adverse events and efficacy of paediatric PSA in a country with a recent establishment of emergency medicine and to describe which factors aided implementation. ⋯ Paediatric PSA provided by the first EPs in The Netherlands showed appropriate levels of sedation and analgesia with a high rate of procedure completion and a low rate of adverse events. Our paper suggests that EPs provided with a proper infrastructure of mentorship, training and guidelines can implement effective paediatric PSA.