Articles: pain-management.
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Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies have also demonstrated cultural differences in the expression and perception of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation. ⋯ Our data illustrate that both adults and children with severe pain resulting from orthopedic injury in the Costa Rican EDs we studied often receive inadequate or no analgesic treatment. This finding suggests that the phenomenon of oligoanalgesia is more widespread and resistant to cultural differences. We also noted a reluctance to use opioids in this setting.
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Pain management is a common concern of elderly patients with chronic cancer pain as well as many nonmalignant chronic illnesses. Family caregivers are central to pain management efforts, particularly in the home-care environment. Pain management is cited as an aspect of caregiving with both physical and emotional demands. ⋯ Education is necessary to dispel common misconceptions regarding pain and use of analgesics, and also to address the emotional aspects of relieving pain. This family education must be preceded by the education of professionals in geriatric care and to the extension of recent advances in pain management into the geriatric population. These advances can provide comfort to elderly patients as well as to the family members who care for them.
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A database of randomised clinical trials (RCTs) in pain research published from 1950 to 1990 was created following an extensive literature search. By applying a refined MEDLINE search strategy from 1966 to 1990 and by hand-searching more than 1,000,000 pages of a total of 40 biomedical journals published during the period 1950-1990, more than 8000 RCTs were identified. The RCTs were published in more than 800 journals and over 85% appeared between 1976 and 1990. ⋯ A detailed description of methods to ensure efficient use of resources during the identification, retrieval and management of the information in pain relief and other fields is given. Emphasis is made on the importance of refining MEDLINE search strategies, on the use of volunteers to hand-search journals and on careful monitoring of each of the steps of the process. The potential uses of the database to guide clinical and research decisions are discussed.