Articles: pain-management.
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Meta Analysis Comparative Study
Efficacy of multidisciplinary pain treatment centers: a meta-analytic review.
Sixty-five studies that evaluated the efficacy of multidisciplinary treatments for chronic back pain were included in a meta-analysis. Within- and between-group effect sizes revealed that multidisciplinary treatments for chronic pain are superior to no treatment, waiting list, as well as single-discipline treatments such as medical treatment or physical therapy. ⋯ These results tend to support the efficacy of multidisciplinary pain treatment; however, these results must be interpreted cautiously as the quality of the study designs and study descriptions is marginal. Suggestions for improvement in research designs as well as appropriate reports of research completed are provided.
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Numerous postoperative analgesic therapies are continuing to develop as interest increases in the control of acute pain, particularly within the specialty of anaesthesia. Further progress will be made in the near future in relation to preemptive analgesia and reduction of postoperative pain by controlling spinal cord plasticity.(41,42) The concept of multimodal or balanced analgesia(43) in which the combined use of specific agents blocking specific segments of the pain pathway is another area which may provide improvements in postoperative analgesia.
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Review Practice Guideline Guideline
Acute pain management: operative or medical procedures and trauma, Part 2. Agency for Health Care Policy and Research.
Summary recommendations 1-5 and 7 should be implemented in every hospital where operations are performed on inpatients. The Acute Pain Management Guideline Panel recommends that any hospital in which abdominal or thoracic operations are routinely performed offer patients postoperative regional anesthetic, epidural or intrathecal opioids, PCA infusions, and other interventions requiring a similar level of expertise, under the supervision of an acute pain service as described in summary recommendation 6. For pain management to be effective, each hospital must designate who or which department will be responsible for all of the required activities. ⋯ Define pain and relief levels to trigger a review. Each institution should identify pain intensity and pain relief levels that will elicit a review of the current pain therapy, documentation of the proposed modifications in treatment, and subsequent review of its efficacy. This process of treatment review and follow-up should include participation by physicians and nurses involved in the patient's care.(ABSTRACT TRUNCATED AT 400 WORDS)
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This retrospective study of long-term use of transcutaneous electrical nerve stimulation (TENS) at Newcastle Pain Relief Clinic indicates that TENS has been a successful analgesic treatment for 58.6% of 1582 patients attending the clinic over a period of 10 years. A wide range of pain conditions were found to respond to TENS and many patients continued to use the treatment for several years. Most patients not responding to TENS (during a home trial) returned stimulators at the first follow-up appointment. Thus TENS should be considered as a simple, safe and reusable first line treatment for many pain conditions.
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Comment Letter Case Reports
In response to article by Drs. Petriccione di Vadi and Hamann.