Articles: pain-management.
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Clinical Trial Controlled Clinical Trial
A collaborative research utilization approach to evaluate the effects of pain management standards on patient outcomes.
The generation of research-based knowledge is incomplete unless it reaches clinicians at the point of care. Despite major advances in clinical research related to pain management, inadequate pain relief has become a significant quality issue in hospitalized patients, which has created an imperative for research-based pain management. Using a collaborative research utilization model, multidisciplinary academic scientists were paired with clinicians and undergraduate and graduate students to form a partnership that (1) examined the research base in pain management, (2) generated a research-based standard for pain management, and (3) evaluated the effect of that standard on four patient outcome variables in a 230-bed teaching hospital. ⋯ Interestingly, each of these improvements decreased after their discharge home. These results strongly suggest the need for better postdischarge preparation for pain management and for further development and testing of pain management standards in postdischarge settings. They also provide the basis for extending the model to address other situations in which there is a lag between the promising results of empirical research and their integration into practice.
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Pain is complex and difficult to define; Managing pain is challenging for all members of the interprofessional team; Untreated pain is harmful to the patient; Pain is a subjective and unique experience for the individual, which we, as health professionals, should not judge; Staff do not know best--listen to what the patient is telling you; Base your evaluation of pain upon a thorough clinical assessment and an evaluation of treatment/care. Use pain measurement tools to aid this process; Effective communication with patients is essential for effective pain management.
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Recent evidence indicates that physicians are at high risk for patient-perpetrated violence. The objectives of this article, in association with case reports of patients with chronic pain (PWCP), are the following: to review the literature and determine if pain physicians could be at risk for PWCP-perpetrated violence; to review the current evaluation and management procedures for potentially violent patients; and to identify some situations specific to PWCPs that can heighten the risk of PWCP-perpetrated violence. ⋯ In the evaluation for risk of violence against physicians or institutions by PWCPs, one needs to understand PWCP-specific situations. Management of potential violent behavior cannot be effective without this understanding.
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Clinical Trial
Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation.
Spinal cord stimulation (SCS) is known to relieve pain in patients with complex regional pain syndrome (CRPS) and, in general, to cause vasodilation. The vasodilatory effect of SCS is hypothesized to be secondary to inhibition of sympathetically mediated vasoconstriction, or through antidromic impulses resulting in release of vasoactive substances. The aim of the present study was to assess whether pain relief in CRPS after SCS is, in fact, dependent on vasodilation. In addition, we tried to determine which of the potential mechanisms may cause the vasodilatory effect that is generally found after SCS. ⋯ The current study failed to show that SCS influences skin microcirculation in patients with CRPS and a low sympathetic tone. Therefore, we may conclude that pain relief in CRPS due to SCS is possible without vasodilation. Because sympathetic activity was greatly decreased in our patients, these results support the hypothesis that the vasodilation that is normally found with SCS is due to an inhibitory effect on sympathetically maintained vasoconstriction.
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Arch Phys Med Rehabil · Jun 2000
Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review.
To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block (SNRB) in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain. ⋯ This study suggests that fluoroscopically guided therapeutic SNRB is a clinically effective intervention in the treatment of atraumatic cervical spondylotic radicular pain.