Articles: pain-clinics.
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Historical Article
[25 years of progress in pain therapy: the rocky road to recognition].
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Venipuncture and intravenous cannulation are among the most common and widespread medical procedures performed on children today. Therefore, effective treatment of venous access pain can benefit from an integrated systems approach that enlists multiple players in the health care system. ⋯ Common themes that arise from these case studies include the importance of a multidisciplinary evidence-based approach to advocate change; a system-wide protocol for the administration of local anesthetics; convenient access to topical local anesthetics; department and hospital-wide support for educational efforts, including training in nonpharmacologic techniques used by child life specialists; and ongoing quantification of the overall success of any program. Implementation of these strategies can result in significant improvements in the pediatric venous access experience.
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Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. ⋯ I. N. Management is a clinician education program providing up-to-date training in pain management.
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A number of variables have contributed to the current crisis in chronic pain care and are affected by, and affect, the philosophies and politics that influence the socio-economic climate of the American healthcare system. Thus, we posit that managing the crisis in chronic pain care in the United States is contingent upon the development of a multi-focal healthcare paradigm that more thoroughly enables and fortifies research, its translation (in education and practice), and the implementation of, and support for, both the curative and healing approaches in medicine in general, and pain care specifically. These steps necessitate re-examination, if not revision of the health care system and its economics. ⋯ But establishing such a system does not guarantee access, and distribution of these services and resources requires economic support to ensure that capabilities are more broadly available (i.e., supplied), and afforded as needed and wanted (i.e., demanded). Toward this end, we posit the need to focus upon, and more fully integrate 1) education, 2) multi-disciplinary care (including re-vivification of MPCs), 3) policies that allow financial subsidies that afford patients the latitude to access and utilize such expanded resources appropriately to meet identified medical needs, and 4) medico-legal initiatives and statutes that protect and enable patients and physicians. The proposed changes comport with a number of ethical systems in that they support the basic deontic structure of the profession and allow for a richer, more finely grained articulation of clinical and ethical responsibilities within the scope of particular general, specialty, and sub-specialty practices.
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Delirium is an acute fluctuating disturbance in cognitive status, linked to increased morbidity and mortality. The purpose of this pilot study was to assess the feasibility in terms of required time and yield of delirium monitoring by the Acute Pain Service (APS) using the Confusion Assessment Method for Intensive Care Unit instrument. ⋯ The use of this tool required little training, and only 2 minutes per patient. It detected more patients with delirium than did the standard nursing assessments or other patient-clinician interactions. The use of this instrument by the pain service was feasible in terms of time consumption and most likely would be valuable in its yield. Early detection may help in initiating prompt treatment, eliminating known risk factors and thus reducing morbidity.