BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vom...BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P=0.43)and post-operative day 2(median:4.7 vs 5.2;P=0.96).No significant differences were found in provider-identified incidences of AKI or GI bleeding during admission.There was no difference in serum creatinine at the time of discharge between the two groups.CONCLUSION A multimodal,opioid-sparing pain management protocol was as effective for pain control and resulted in significantly less opioid daily exposure over LOS.No adverse events were found related to use of ketorolac in patients undergoing donor nephrectomy.Our findings suggest that an opioid-sparing protocol is both safe and effective at minimizing opioid exposure and managing post-operative pain within the first 48 hours post-surgery.展开更多
The gut microbiome,a complex ecosystem of microorganisms,has a significant role in modulating pain,particularly within orthopaedic conditions.Its impact on immune and neurological functions is underscored by the gut-b...The gut microbiome,a complex ecosystem of microorganisms,has a significant role in modulating pain,particularly within orthopaedic conditions.Its impact on immune and neurological functions is underscored by the gut-brain axis,which influences inflammation,pain perception,and systemic immune responses.This integrative review examines current research on how gut dysbiosis is associated with various pain pathways,notably nociceptive and neuroinflammatory mechanisms linked to central sensitization.We highlight advancements in meta-omics technologies,such as metagenomics and metaproteomics,which deepen our understanding of microbiome-host interactions and their implications in pain.Recent studies emphasize that gut-derived short-chain fatty acids and microbial metabolites play roles in modulating neuroinflammation and nociception,contributing to pain management.Probiotics,prebiotics,synbiotics,and faecal microbiome transplants are explored as potential therapeutic strategies to alleviate pain through gut microbiome modulation,offering an adjunct or alternative to opioids.However,variability in individual microbiomes poses challenges to standardizing these treatments,necessitating further rigorous clinical trials.A multidisciplinary approach combining microbiology,immunology,neurology,and orthopaedics is essential to develop innovative,personalized pain management strategies rooted in gut health,with potential to transform orthopaedic pain care.展开更多
BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverage...BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverages the complementary mechanisms of action,providing more effective relief for conditions such as arthritis,muscle spasms,and soft tissue injuries.AIM To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.METHODS A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone.A retrospective analysis of electronic medical records from India spanning 3 years(2020-2023)examined treatment patterns and focused on clinical outcomes including pain relief,functional improvement,and adverse effects.Key metrics for assessment included visual analog scale scores and hand-to-floor distance,with secondary outcomes assessing patient satisfaction and adverse event(AE)incidence.RESULTS A systematic literature search revealed seven studies,involving 1137 subjects,aligning with the eligibility criteria from a total of 833 hits.Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity[standardised mean difference(SMD):-1.33,P<0.001]and enhanced functional improvement(SMD:-1.08,P<0.001)compared to NSAIDs alone.Patients on combination therapy are 6.7 times more likely to experience over 30%pain relief and 5.2 times more likely to achieve over 50%pain relief.Post surgery pain reduction and patient satisfaction were notably higher in the combination group[odds ratio(OR)=10.14,P<0.001].There were no significant differences in mild/moderate AE rates between the groups(OR=1.30,P=0.378).CONCLUSION Evidence indicates that multimodal therapy,including parenteral TCC with NSAIDs,provides quicker and effective pain relief,reduces muscle spasms,and improves hand-to-floor distance compared to using NSAIDs or TCC alone.展开更多
In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage ...In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors.The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients,highlighting significant benefits in pain control,reduction of opioid dosage,and minimization of adverse reactions.In our article,we not only discuss these fin-dings but also emphasize the broader implications for clinical practice,parti-cularly in enhancing patient outcomes through innovative pain management strategies.We advocate for further research to establish more robust data su-pporting this approach and to explore the mechanistic insights that enable these benefits.This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain,urging a reevaluation of current practices to incorporate these findings effectively.展开更多
This editorial highlights the randomized controlled trial by Qian et al evaluating the efficacy of nalbuphine in managing postoperative pain and associated inflammatory factors in patients undergoing radical gastrecto...This editorial highlights the randomized controlled trial by Qian et al evaluating the efficacy of nalbuphine in managing postoperative pain and associated inflammatory factors in patients undergoing radical gastrectomy for gastric cancer.Utilizing a multimodal analgesic approach with a controlled analgesia pump and a transverse abdominis muscle plane block,the study compared nalbuphine against sufentanil.Results indicate that nalbuphine significantly reduces pain scores at various postoperative intervals,decreases consumption and patientcontrolled analgesia presses,and lowers levels of pain markers such as prostaglandin E2,serotonin,and substance P.While both agents demonstrated effective pain control,nalbuphine was associated with a lower incidence of adverse effects,suggesting its potential as a valuable alternative in appropriate clinical scenarios.This study offers valuable insights into nalbuphine’s clinical applicability,underscoring its benefits for pain management and enhancing patient recovery in the postoperative setting.展开更多
BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the compa...BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.METHODS PubMed,Embase and the Cochrane Library were comprehensively searched to identify cohort studies.The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials.PRISMA guidelines were followed.The effectiveness of the administration routes was compared based on visual analogue scale(VAS)scores at 24 and 48 h,total morphine usage within 24 h,and total duration of hospital stay.RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups.The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h(P=0.76 and 0.08,respectively).The difference in total morphine use between the two groups was not significant(P=0.22).However,the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups(P=0.0005),showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.CONCLUSION After TJA surgery,intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia,Oral administration has become the preferred choice for mild cases due to its convenience and economy,providing a basis for clinical drug selection.展开更多
Objective:To conduct a scoping review on the application status of the Functional Activity Score(FAS)in postoperative active pain management in China,providing a reference for its standardized and normative promotion....Objective:To conduct a scoping review on the application status of the Functional Activity Score(FAS)in postoperative active pain management in China,providing a reference for its standardized and normative promotion.Methods:Computerized searches of Chinese and English databases were performed to collect studies published by Chinese scholars from 2005 to July 2025 on the application of FAS in postoperative active pain management.After strict screening,the basic characteristics,application fields,assessment models,evaluation timing,types of functional activities,and clinical outcomes of the included literature were systematically analyzed.Results:A total of 18 studies were included,involving surgical types such as thoracic surgery,general surgery,and orthopedics.All studies adopted FAS combined with the Numeric Rating Scale(NRS)for assessment,with evaluation timing mostly concentrated within 72 hours postoperatively.The selected functional activities primarily included respiration-related and limb movements.Evaluation indicators covered pain control,functional recovery,complications,adverse events,patient experience,and tool assessment,with most studies reporting positive outcomes.Conclusion:FAS can effectively enhance pain control and promote functional recovery in postoperative active pain management in China,demonstrating high clinical value.However,existing studies exhibit inconsistencies in assessment criteria,selection of activity types,and research quality.展开更多
BACKGROUND Effective pain management after radical gastrectomy is crucial for patient recovery.With the promotion of enhanced recovery after surgery protocols,postoperative pain management has become a core component ...BACKGROUND Effective pain management after radical gastrectomy is crucial for patient recovery.With the promotion of enhanced recovery after surgery protocols,postoperative pain management has become a core component of perioperative care.However,controversy remains regarding the optimal frequency of analgesic titration for pain control.AIM To compare the efficacy of 12-hour vs 24-hour titration regimens in postoperative pain management following radical gastrectomy for gastric cancer.METHODS This retrospective comparative study analyzed data from 120 patients who underwent radical gastrectomy between January 2021 and December 2022,with 52 patients receiving a 12-hour titration regimen and 68 patients receiving a 24-hour titration regimen.All patients received patient-controlled intravenous analgesia containing sufentanil and tropisetron postoperatively with identical initial settings.RESULTS The 12-hour titration group demonstrated significantly lower pain scores at 12 hours postoperatively compared to the 24-hour group(3.2 vs 4.8,P<0.001);total analgesic consumption(morphine equivalents)was reduced by 28.6%(30 mg vs 42 mg,P<0.001);postoperative nausea and vomiting decreased by 50%(15%vs 30%,P=0.02);respiratory depression was less frequent(2%vs 8%,P=0.04);patient satisfaction was higher(85%vs 65%reporting“very satisfied”or“satisfied”,P<0.001);and hospital stay was shortened by 12.5%(4.2 days vs 4.8 days,P=0.02).Cox regression analysis showed that the 12-hour regimen was associated with a lower risk of prolonged high-intensity pain(hazard ratio=0.65,95%confidence interval:0.45-0.93,P=0.02),and multivariate regression analysis confirmed that the 12-hour regimen was an independent predictor of better overall recovery(β=-0.32,P=0.01).CONCLUSION Compared to the 24-hour titration regimen,the 12-hour titration regimen provided more effective control of early postoperative pain after radical gastrectomy,reduced total analgesic consumption,lowered the incidence of related adverse reactions,improved patient satisfaction,and shortened hospital stays.展开更多
Objective:To systematically evaluate the effectiveness of research-oriented integrated nursing interventions on cancer pain management in hospitalized oncology patients in China.Methods:A computerized search of Chines...Objective:To systematically evaluate the effectiveness of research-oriented integrated nursing interventions on cancer pain management in hospitalized oncology patients in China.Methods:A computerized search of Chinese and English databases was conducted to identify relevant studies.Two researchers independently assessed the quality of included literature using the Newcastle-Ottawa Scale(NOS).Data were extracted and analyzed via Stata 14.A random-effects model was applied due to significant heterogeneity(I²>50%).Sensitivity analysis and Egger’s test were performed to assess bias.Results:12 eligible studies(2014-2024)were included.Meta-analysis demonstrated that integrated nursing interventions significantly reduced cancer pain scores compared to routine care(SMD=-1.51,95%CI:-1.90 to-1.12;I²=84.8%),with superior efficacy.Subgroup-analyses revealed enhanced effects for“Nursing modes”(SMD=-2.11)and“cancer pain education”(SMD=-2.30).Conclusion:Research-oriented integrated nursing interventions significantly improve cancer pain management in Chinese hospitalized oncology patients,particularly through synergistic effects of“Nursing modes”and“can-cer pain education.”However,implementation bias from“additive interventions”in teaching hospitals and high heterogeneity warrant attention.Future studies should optimize designs to enhance clinical applicability.展开更多
Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of suc...Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.展开更多
Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chr...Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.展开更多
Introduction: Pain management in pediatric patients is a critical aspect of healthcare delivery, yet it remains a significant challenge globally, particularly in low- and middle-income countries like Zambia. Aim: To e...Introduction: Pain management in pediatric patients is a critical aspect of healthcare delivery, yet it remains a significant challenge globally, particularly in low- and middle-income countries like Zambia. Aim: To evaluate the practices of pediatric pain management among nursing students at Gateway to Better Living and Monze College of Nursing in Zambia, identifying associated factors and areas for improvement. Design and Methods: A quantitative analytical cross-sectional design was used. A sample of 197 students was selected using a stratified proportional simple random method from the two schools. Data were collected through a self-administered questionnaire using validated scales extracted from the Pediatric Nurse’s Knowledge and Attitude Survey. The collected data were entered into SPSS version 27 for analysis of descriptive and inferential statistics. The Chi-square, and binary logistic regression tests were employed to statistically analyse the data. A confidence interval of 95% with a significance level of 5% was set. Results: Analysis of pediatric pain management practices among 197 nursing students revealed a mixed picture. While adherence to institutional policies and supportive measures was high, areas for improvement were identified in the utilization of pain assessment tools and reassessment post-medication. Attitudes were generally favorable, with 62.4% exhibiting positive attitudes. However, knowledge levels varied, with 63.5% deemed to have adequate knowledge. Chi-square tests indicated significant associations between practices and knowledge levels (p Conclusion and Recommendations: The study underscores the importance of addressing gaps in pediatric pain management among nursing students in Zambia. Recommendations include curriculum revisions, interdisciplinary training, and policy advocacy to bridge these gaps. Targeted interventions are essential to enhance pediatric pain management practices and ensure holistic care for pediatric patients.展开更多
Objective： To investigate patients＇ attitudes towards cancer pain management and analyze the factors influencing these attitudes.Methods： The self-developed Demographic and Disease-Related Information Questionnaire...Objective： To investigate patients＇ attitudes towards cancer pain management and analyze the factors influencing these attitudes.Methods： The self-developed Demographic and Disease-Related Information Questionnaires, Pain Management Barriers Questionnaire-Taiwan form（BQT）, and Pain Knowledge Questionnaire were administered to 363 pairs of hospitalized cancer patients and their caregivers from the oncology departments of 7 hospitals in Beijing, China.Results： The average patient score for attitudes towards pain management was 2.96±0.49. The dimension scores indicated good attitudes in three areas（scores 〈2.5）, ＂Desire to be good＂（2.22±1.04）, ＂Fatalism＂（2.08±0.81） and＂Religious fatalism＂（1.86±1.00）, and poor attitudes in six areas（scores ≥2.5）, ＂Tolerance＂（3.83±0.96）, ＂Use of analgesics as needed（p.r.n.）＂（3.73±1.01）, ＂Addiction＂（3.44±1.05）, ＂Disease progression＂（3.28±1.26）, ＂Distraction of physicians＂（3.16±1.07） and ＂Side effects＂（2.99±0.68）. Two factors were entered into the regression equation：the caregivers＇ attitudes towards cancer pain management and the patients＇ pain knowledge. These two factors explained 23.2% of the total variance in the patients＇ average scores for their attitudes towards cancer pain management.Conclusions： The patients＇ attitudes towards cancer pain management were poor and could be influenced by the caregivers＇ attitudes and the patients＇ pain knowledge, and thus need to be improved.展开更多
Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of life.Pain control,therefore,remains central to the overall management of chronic pa...Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of life.Pain control,therefore,remains central to the overall management of chronic pancreatitis.Most of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another,as there are no uniform guidelines to direct a stepwise approach towards achieving this goal.In this editorial,we comment on best practice strategies targeted towards pain control in chronic pancreatitis,specifically highlighting the use of opioid medications in this patient population.We discuss various safe and efficacious prescription monitoring practices in this article.展开更多
Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on ...Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain,pain assessment,pharmacological and nonpharmacological management,and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team.Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used.The Clinical Pain Knowledge Test(CPKT)was completed by 135 and 107 nurses from 17 surgical wards pre and post-program,respectively.Two hundred and three patients’medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention,respectively.Documentation of patients’postoperative pain management nursing practice behaviors and pain intensity scores were collected.Results:After the intervention,the CPKT scores of nurses significantly increased from 45.6%±12.3%to 54.2%±10.2%(t=5.786,P<0.001).Nurses’postoperative pain management nursing practice improved,with proportion of pain assessment documentation increased from 59.6%(121/203)to 74.9%(152/203)(χ^(2)=10.746,P=0.001),those using pain intensity assessment tools increased from 81.8%(99/121)to 95.4%(145/152)(χ^(2)=13.079,P<0.001),and intramuscular injection of nonopioids decreased from 12.6%(13/103)to 2.7%(3/111)(χ^(2)=7.598,P=0.006).Patients’average worst pain score on the operation day significantly decreased(Z=-2.486,P=0.013),and scores from the first to the third postoperative day also decreased(Z=-2.172,P=0.030).Conclusions:Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management,improve selected pain management practices,and decrease patients’postoperative pain intensity.展开更多
Total knee arthroplasty （TKA） can contribute to significant pain for the patient. Continuous peripheral nerve blocks （CPNBs） have been shown to be efficacious in treating post-surgical pain. The objective of this ...Total knee arthroplasty （TKA） can contribute to significant pain for the patient. Continuous peripheral nerve blocks （CPNBs） have been shown to be efficacious in treating post-surgical pain. The objective of this study is to determine the efficacy of a bupivacaine 0.2% solution administered via CPNB plus standard of care （SOC） compared to SOC alone. SOC for this institution includes the use of opioid analgesics, non-opioid analgesics, regional anesthesia, and other adjuncts. The primary outcome is the overall use of post-operative pain medication. Secondary outcomes include the average length of stay and average pain scores. Methods： A data surveillance system was used to retrospectively identify all patients who underwent TKA with and without the use of CPNB. To be included, patients must have been male or female ≥ 18 years of age who underwent TKA from September 2016 through September 2017. And 70 patients were included in both the CPNB and SOC groups. A retrospective chart review determined the following data： The types and amounts of pain medications used, the length of stay, and patient-reported pain scores. Results： There was an increase in the amount of as needed pain medication use in the CPNB ＋ SOC vs. SOC group with 12.97 administrations vs. 12.67 administrations respectively. Length of stay was increased in the CPNB ＋ SOC vs. SOC group with 3.65 days in the CPNB ＋ SOC group vs. 3.5 days in the SOC group. Pain scores were increased in the CPNB ＋ SOC group with a patient average pain score of 4.5 vs. the SOC groups average pain score of 4.4. Conclusions： The use of a 0.2% bupivacaine solution administered via CPNB in addition to SOC resulted in increased utilization of as needed pain medication administration, increased average length of stay, and increased average pain scores when compared to SOC alone.展开更多
BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body s...BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE： To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING： A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （Ganzhou, Jiangxi Province, China） from January 2005 to February 2006. PARTICIPANTS： Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （China）, were included in this study. METHODS： Forty patients underwent neurosurgery and were randomly divided into two groups： patient-controlled analgesia plus HANS （＋HANS, n = 20） and patient-controlled analgesia （-HANS, n = 20）. Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. （China）. Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing （China）, with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE： The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS： Compared with the HANS group, the visual analogue scale scores were remarkably lower in the ＋HANS group six hours after surgery （P 〈 0.01）, and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased （P 〈 0.05）.CONCLUSION： The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.展开更多
Objective: The aim of the study was to investigate advanced medical students' knowledge towards cancer pain management, and understand the effect of specialisms and duration of oncology rotation on the advanced me...Objective: The aim of the study was to investigate advanced medical students' knowledge towards cancer pain management, and understand the effect of specialisms and duration of oncology rotation on the advanced medical students' cognitive level towards cancer pain management. Methods: Randomly selected the respondents from a medical school in Wuhan, China. The educational background of the respondents should belong to one of these conditions: (1) clinical master degree candidate; (2) clinical doctor degree candidate; (3) the sixth or seventh year of clinical medicine for seven years. The respondents should also spend more than one year on internship. The self-developed questionnaire papers were distributed to respondents in the unit of dorms selected randomly and recovered them immediately after they're finished. The categori- cal data were expressed at the form of frequency (rate or constituent ratio). Chi-square test was required only as needed. Results: The survey was anonymous. We distributed 300 papers, recovered 300 papers and weeded out 8 invalid papers. Finally there were 292 valid papers, and the valid recovery rate was 97.3%. The 96.7% of oncological medical students and 47.6% non-oncological medical students relied on patients' description for cancer pain assessments; 90.0% of oncological medical students and 53.0% of non-oncological medical students prescribed strong opioid drugs firstly for patients suffering severe cancer pain; only 24.1% of non-oncological medical students recognized that pethidine was not safe and effective to treat cancer pain, which was much lower than oncological medical students (90.0%); 73.3% of oncological medical students and 28.9% of non-oncological medical students had the correct impression of drug addiction; 85.5% of non-oncological medi- cal students worried about the drug addiction, while 60.0% of oncological medical students worried about the strict control over opioid. In respect of the details of cancer pain management, only 66.7% of oncological medical students recognized that there was no upper limit of opioid prescribed clinically, and 16.3% of oncological medical students recognized that there was no psychological dependence if patients took opioid orally. The 69.8% of the students from no-less-than-two-week group relied on patients' description for cancer pain assessments, 76.7% prescribed strong opioid drugs firstly for patients suffer- ing severe cancer pain, 69.8% recognized that pethidine was not safe and effective to treat cancer pain, and 55.8% had the correct impression of drug addiction. All of the data were higher than that in no-rotation group and that in less-than-two-week group. The 51.2% of the students from no-less-than-two-week worried about drug addiction, which was the lowest of all. Conclusion: The cognitive level of advanced medical students towards cancer pain management is so low that it could not satisfy the clinical requirement, especially for the non-oncological medical students and the students spending little time on oncology rotation. Though the oncological medical students know something about cancer pain treatment, they know little about the details.展开更多
Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmaco...Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar,Cross River State,Nigeria.Materials and Methods:A descriptive cross-sectional design was used for the study.The study was rooted in Katherine Kolcaba’s Comfort theory.Totally,67 participants were recruited for the study using the purposive sampling technique.A self-made structured questionnaire was used to obtain participants’information on knowledge,utilization,and predictors of nonpharmacological pain relief measures.Results:Although 41(61.2%)of the participants had knowledge about nonpharmacological pain relief measures,few did not know some of the cognitive-behavioral and environmental measures in labor pain management.There was 35.8%(24/67)for utilization of cognitive-behavioral measures and 55.2%(37/67)for psychological/emotional measures for labor pain management by respondents,respectively.Fifty(74.6%)of respondents agreed that predictors such as lack of knowledge,lack of updates and training,work experience,best practice guidelines,and equipment were hindrances to utilization.There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures(r=0.6,P<0.05).Conclusion:The utilization of nonpharmacological measures for labor pain management is low,thus it is recommended that frequent education,training updates on effective labor pain management,provision of clinical guidelines on labor pain management,and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.展开更多
Neonatal pain management is an important issue which should have great attention.More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination,heel stick,and so...Neonatal pain management is an important issue which should have great attention.More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination,heel stick,and so on,and it will result in shortterm and long-term outcomes.So it is very important to manage neonatal pain.This article summarized some non-pharmaceutical interventions,including sucrose or glucose,non-nutritional sucking(NNS),breastfeeding,facilitated tucking(FT),kangaroo mother care(KMC),swaddling,heel warming,sensorial saturation(SS),and music therapy,which showed obvious effects for neonatal pain.In addition,this article summarized the progress of neonatal pain intervention in various countries and showed that many countries have not paid enough attention to this problem,while some countries have carried out promotion programs for neonatal pain management which give some clinical enlightenment to our country that we need to pay more attention to this problem.展开更多
文摘BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P=0.43)and post-operative day 2(median:4.7 vs 5.2;P=0.96).No significant differences were found in provider-identified incidences of AKI or GI bleeding during admission.There was no difference in serum creatinine at the time of discharge between the two groups.CONCLUSION A multimodal,opioid-sparing pain management protocol was as effective for pain control and resulted in significantly less opioid daily exposure over LOS.No adverse events were found related to use of ketorolac in patients undergoing donor nephrectomy.Our findings suggest that an opioid-sparing protocol is both safe and effective at minimizing opioid exposure and managing post-operative pain within the first 48 hours post-surgery.
文摘The gut microbiome,a complex ecosystem of microorganisms,has a significant role in modulating pain,particularly within orthopaedic conditions.Its impact on immune and neurological functions is underscored by the gut-brain axis,which influences inflammation,pain perception,and systemic immune responses.This integrative review examines current research on how gut dysbiosis is associated with various pain pathways,notably nociceptive and neuroinflammatory mechanisms linked to central sensitization.We highlight advancements in meta-omics technologies,such as metagenomics and metaproteomics,which deepen our understanding of microbiome-host interactions and their implications in pain.Recent studies emphasize that gut-derived short-chain fatty acids and microbial metabolites play roles in modulating neuroinflammation and nociception,contributing to pain management.Probiotics,prebiotics,synbiotics,and faecal microbiome transplants are explored as potential therapeutic strategies to alleviate pain through gut microbiome modulation,offering an adjunct or alternative to opioids.However,variability in individual microbiomes poses challenges to standardizing these treatments,necessitating further rigorous clinical trials.A multidisciplinary approach combining microbiology,immunology,neurology,and orthopaedics is essential to develop innovative,personalized pain management strategies rooted in gut health,with potential to transform orthopaedic pain care.
文摘BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverages the complementary mechanisms of action,providing more effective relief for conditions such as arthritis,muscle spasms,and soft tissue injuries.AIM To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.METHODS A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone.A retrospective analysis of electronic medical records from India spanning 3 years(2020-2023)examined treatment patterns and focused on clinical outcomes including pain relief,functional improvement,and adverse effects.Key metrics for assessment included visual analog scale scores and hand-to-floor distance,with secondary outcomes assessing patient satisfaction and adverse event(AE)incidence.RESULTS A systematic literature search revealed seven studies,involving 1137 subjects,aligning with the eligibility criteria from a total of 833 hits.Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity[standardised mean difference(SMD):-1.33,P<0.001]and enhanced functional improvement(SMD:-1.08,P<0.001)compared to NSAIDs alone.Patients on combination therapy are 6.7 times more likely to experience over 30%pain relief and 5.2 times more likely to achieve over 50%pain relief.Post surgery pain reduction and patient satisfaction were notably higher in the combination group[odds ratio(OR)=10.14,P<0.001].There were no significant differences in mild/moderate AE rates between the groups(OR=1.30,P=0.378).CONCLUSION Evidence indicates that multimodal therapy,including parenteral TCC with NSAIDs,provides quicker and effective pain relief,reduces muscle spasms,and improves hand-to-floor distance compared to using NSAIDs or TCC alone.
基金Supported by the Shandong Province Medical and Health Science and Technology Development Plan Project,No.202203030713Science and Technology Program of Yantai Affiliated Hospital of Binzhou Medical University,No.YTFY2022KYQD06.
文摘In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors.The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients,highlighting significant benefits in pain control,reduction of opioid dosage,and minimization of adverse reactions.In our article,we not only discuss these fin-dings but also emphasize the broader implications for clinical practice,parti-cularly in enhancing patient outcomes through innovative pain management strategies.We advocate for further research to establish more robust data su-pporting this approach and to explore the mechanistic insights that enable these benefits.This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain,urging a reevaluation of current practices to incorporate these findings effectively.
基金Supported by National Natural Science Foundation of China,No.82404612.
文摘This editorial highlights the randomized controlled trial by Qian et al evaluating the efficacy of nalbuphine in managing postoperative pain and associated inflammatory factors in patients undergoing radical gastrectomy for gastric cancer.Utilizing a multimodal analgesic approach with a controlled analgesia pump and a transverse abdominis muscle plane block,the study compared nalbuphine against sufentanil.Results indicate that nalbuphine significantly reduces pain scores at various postoperative intervals,decreases consumption and patientcontrolled analgesia presses,and lowers levels of pain markers such as prostaglandin E2,serotonin,and substance P.While both agents demonstrated effective pain control,nalbuphine was associated with a lower incidence of adverse effects,suggesting its potential as a valuable alternative in appropriate clinical scenarios.This study offers valuable insights into nalbuphine’s clinical applicability,underscoring its benefits for pain management and enhancing patient recovery in the postoperative setting.
基金Supported by National Natural Science Foundation of China,No.11772226 and No.81572154.
文摘BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.METHODS PubMed,Embase and the Cochrane Library were comprehensively searched to identify cohort studies.The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials.PRISMA guidelines were followed.The effectiveness of the administration routes was compared based on visual analogue scale(VAS)scores at 24 and 48 h,total morphine usage within 24 h,and total duration of hospital stay.RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups.The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h(P=0.76 and 0.08,respectively).The difference in total morphine use between the two groups was not significant(P=0.22).However,the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups(P=0.0005),showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.CONCLUSION After TJA surgery,intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia,Oral administration has become the preferred choice for mild cases due to its convenience and economy,providing a basis for clinical drug selection.
基金School-level Educational Reform Project of Hangzhou Normal University(Project No.:HLXYJG202304)。
文摘Objective:To conduct a scoping review on the application status of the Functional Activity Score(FAS)in postoperative active pain management in China,providing a reference for its standardized and normative promotion.Methods:Computerized searches of Chinese and English databases were performed to collect studies published by Chinese scholars from 2005 to July 2025 on the application of FAS in postoperative active pain management.After strict screening,the basic characteristics,application fields,assessment models,evaluation timing,types of functional activities,and clinical outcomes of the included literature were systematically analyzed.Results:A total of 18 studies were included,involving surgical types such as thoracic surgery,general surgery,and orthopedics.All studies adopted FAS combined with the Numeric Rating Scale(NRS)for assessment,with evaluation timing mostly concentrated within 72 hours postoperatively.The selected functional activities primarily included respiration-related and limb movements.Evaluation indicators covered pain control,functional recovery,complications,adverse events,patient experience,and tool assessment,with most studies reporting positive outcomes.Conclusion:FAS can effectively enhance pain control and promote functional recovery in postoperative active pain management in China,demonstrating high clinical value.However,existing studies exhibit inconsistencies in assessment criteria,selection of activity types,and research quality.
基金Supported by Wenzhou Science and Technology Bureau,No.Y20220877.
文摘BACKGROUND Effective pain management after radical gastrectomy is crucial for patient recovery.With the promotion of enhanced recovery after surgery protocols,postoperative pain management has become a core component of perioperative care.However,controversy remains regarding the optimal frequency of analgesic titration for pain control.AIM To compare the efficacy of 12-hour vs 24-hour titration regimens in postoperative pain management following radical gastrectomy for gastric cancer.METHODS This retrospective comparative study analyzed data from 120 patients who underwent radical gastrectomy between January 2021 and December 2022,with 52 patients receiving a 12-hour titration regimen and 68 patients receiving a 24-hour titration regimen.All patients received patient-controlled intravenous analgesia containing sufentanil and tropisetron postoperatively with identical initial settings.RESULTS The 12-hour titration group demonstrated significantly lower pain scores at 12 hours postoperatively compared to the 24-hour group(3.2 vs 4.8,P<0.001);total analgesic consumption(morphine equivalents)was reduced by 28.6%(30 mg vs 42 mg,P<0.001);postoperative nausea and vomiting decreased by 50%(15%vs 30%,P=0.02);respiratory depression was less frequent(2%vs 8%,P=0.04);patient satisfaction was higher(85%vs 65%reporting“very satisfied”or“satisfied”,P<0.001);and hospital stay was shortened by 12.5%(4.2 days vs 4.8 days,P=0.02).Cox regression analysis showed that the 12-hour regimen was associated with a lower risk of prolonged high-intensity pain(hazard ratio=0.65,95%confidence interval:0.45-0.93,P=0.02),and multivariate regression analysis confirmed that the 12-hour regimen was an independent predictor of better overall recovery(β=-0.32,P=0.01).CONCLUSION Compared to the 24-hour titration regimen,the 12-hour titration regimen provided more effective control of early postoperative pain after radical gastrectomy,reduced total analgesic consumption,lowered the incidence of related adverse reactions,improved patient satisfaction,and shortened hospital stays.
文摘Objective:To systematically evaluate the effectiveness of research-oriented integrated nursing interventions on cancer pain management in hospitalized oncology patients in China.Methods:A computerized search of Chinese and English databases was conducted to identify relevant studies.Two researchers independently assessed the quality of included literature using the Newcastle-Ottawa Scale(NOS).Data were extracted and analyzed via Stata 14.A random-effects model was applied due to significant heterogeneity(I²>50%).Sensitivity analysis and Egger’s test were performed to assess bias.Results:12 eligible studies(2014-2024)were included.Meta-analysis demonstrated that integrated nursing interventions significantly reduced cancer pain scores compared to routine care(SMD=-1.51,95%CI:-1.90 to-1.12;I²=84.8%),with superior efficacy.Subgroup-analyses revealed enhanced effects for“Nursing modes”(SMD=-2.11)and“cancer pain education”(SMD=-2.30).Conclusion:Research-oriented integrated nursing interventions significantly improve cancer pain management in Chinese hospitalized oncology patients,particularly through synergistic effects of“Nursing modes”and“can-cer pain education.”However,implementation bias from“additive interventions”in teaching hospitals and high heterogeneity warrant attention.Future studies should optimize designs to enhance clinical applicability.
文摘Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.
文摘Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.
文摘Introduction: Pain management in pediatric patients is a critical aspect of healthcare delivery, yet it remains a significant challenge globally, particularly in low- and middle-income countries like Zambia. Aim: To evaluate the practices of pediatric pain management among nursing students at Gateway to Better Living and Monze College of Nursing in Zambia, identifying associated factors and areas for improvement. Design and Methods: A quantitative analytical cross-sectional design was used. A sample of 197 students was selected using a stratified proportional simple random method from the two schools. Data were collected through a self-administered questionnaire using validated scales extracted from the Pediatric Nurse’s Knowledge and Attitude Survey. The collected data were entered into SPSS version 27 for analysis of descriptive and inferential statistics. The Chi-square, and binary logistic regression tests were employed to statistically analyse the data. A confidence interval of 95% with a significance level of 5% was set. Results: Analysis of pediatric pain management practices among 197 nursing students revealed a mixed picture. While adherence to institutional policies and supportive measures was high, areas for improvement were identified in the utilization of pain assessment tools and reassessment post-medication. Attitudes were generally favorable, with 62.4% exhibiting positive attitudes. However, knowledge levels varied, with 63.5% deemed to have adequate knowledge. Chi-square tests indicated significant associations between practices and knowledge levels (p Conclusion and Recommendations: The study underscores the importance of addressing gaps in pediatric pain management among nursing students in Zambia. Recommendations include curriculum revisions, interdisciplinary training, and policy advocacy to bridge these gaps. Targeted interventions are essential to enhance pediatric pain management practices and ensure holistic care for pediatric patients.
文摘Objective： To investigate patients＇ attitudes towards cancer pain management and analyze the factors influencing these attitudes.Methods： The self-developed Demographic and Disease-Related Information Questionnaires, Pain Management Barriers Questionnaire-Taiwan form（BQT）, and Pain Knowledge Questionnaire were administered to 363 pairs of hospitalized cancer patients and their caregivers from the oncology departments of 7 hospitals in Beijing, China.Results： The average patient score for attitudes towards pain management was 2.96±0.49. The dimension scores indicated good attitudes in three areas（scores 〈2.5）, ＂Desire to be good＂（2.22±1.04）, ＂Fatalism＂（2.08±0.81） and＂Religious fatalism＂（1.86±1.00）, and poor attitudes in six areas（scores ≥2.5）, ＂Tolerance＂（3.83±0.96）, ＂Use of analgesics as needed（p.r.n.）＂（3.73±1.01）, ＂Addiction＂（3.44±1.05）, ＂Disease progression＂（3.28±1.26）, ＂Distraction of physicians＂（3.16±1.07） and ＂Side effects＂（2.99±0.68）. Two factors were entered into the regression equation：the caregivers＇ attitudes towards cancer pain management and the patients＇ pain knowledge. These two factors explained 23.2% of the total variance in the patients＇ average scores for their attitudes towards cancer pain management.Conclusions： The patients＇ attitudes towards cancer pain management were poor and could be influenced by the caregivers＇ attitudes and the patients＇ pain knowledge, and thus need to be improved.
文摘Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of life.Pain control,therefore,remains central to the overall management of chronic pancreatitis.Most of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another,as there are no uniform guidelines to direct a stepwise approach towards achieving this goal.In this editorial,we comment on best practice strategies targeted towards pain control in chronic pancreatitis,specifically highlighting the use of opioid medications in this patient population.We discuss various safe and efficacious prescription monitoring practices in this article.
基金supported by the IASP Developing Countries Project:Initiative for Improving Pain Education.
文摘Objective:To investigate the effect of a pain management core competency education program on surgical nurses’pain knowledge and pain management nursing practice behaviors.Methods:An 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain,pain assessment,pharmacological and nonpharmacological management,and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team.Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used.The Clinical Pain Knowledge Test(CPKT)was completed by 135 and 107 nurses from 17 surgical wards pre and post-program,respectively.Two hundred and three patients’medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention,respectively.Documentation of patients’postoperative pain management nursing practice behaviors and pain intensity scores were collected.Results:After the intervention,the CPKT scores of nurses significantly increased from 45.6%±12.3%to 54.2%±10.2%(t=5.786,P<0.001).Nurses’postoperative pain management nursing practice improved,with proportion of pain assessment documentation increased from 59.6%(121/203)to 74.9%(152/203)(χ^(2)=10.746,P=0.001),those using pain intensity assessment tools increased from 81.8%(99/121)to 95.4%(145/152)(χ^(2)=13.079,P<0.001),and intramuscular injection of nonopioids decreased from 12.6%(13/103)to 2.7%(3/111)(χ^(2)=7.598,P=0.006).Patients’average worst pain score on the operation day significantly decreased(Z=-2.486,P=0.013),and scores from the first to the third postoperative day also decreased(Z=-2.172,P=0.030).Conclusions:Implementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management,improve selected pain management practices,and decrease patients’postoperative pain intensity.
文摘Total knee arthroplasty （TKA） can contribute to significant pain for the patient. Continuous peripheral nerve blocks （CPNBs） have been shown to be efficacious in treating post-surgical pain. The objective of this study is to determine the efficacy of a bupivacaine 0.2% solution administered via CPNB plus standard of care （SOC） compared to SOC alone. SOC for this institution includes the use of opioid analgesics, non-opioid analgesics, regional anesthesia, and other adjuncts. The primary outcome is the overall use of post-operative pain medication. Secondary outcomes include the average length of stay and average pain scores. Methods： A data surveillance system was used to retrospectively identify all patients who underwent TKA with and without the use of CPNB. To be included, patients must have been male or female ≥ 18 years of age who underwent TKA from September 2016 through September 2017. And 70 patients were included in both the CPNB and SOC groups. A retrospective chart review determined the following data： The types and amounts of pain medications used, the length of stay, and patient-reported pain scores. Results： There was an increase in the amount of as needed pain medication use in the CPNB ＋ SOC vs. SOC group with 12.97 administrations vs. 12.67 administrations respectively. Length of stay was increased in the CPNB ＋ SOC vs. SOC group with 3.65 days in the CPNB ＋ SOC group vs. 3.5 days in the SOC group. Pain scores were increased in the CPNB ＋ SOC group with a patient average pain score of 4.5 vs. the SOC groups average pain score of 4.4. Conclusions： The use of a 0.2% bupivacaine solution administered via CPNB in addition to SOC resulted in increased utilization of as needed pain medication administration, increased average length of stay, and increased average pain scores when compared to SOC alone.
文摘BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE： To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING： A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （Ganzhou, Jiangxi Province, China） from January 2005 to February 2006. PARTICIPANTS： Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （China）, were included in this study. METHODS： Forty patients underwent neurosurgery and were randomly divided into two groups： patient-controlled analgesia plus HANS （＋HANS, n = 20） and patient-controlled analgesia （-HANS, n = 20）. Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. （China）. Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing （China）, with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE： The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS： Compared with the HANS group, the visual analogue scale scores were remarkably lower in the ＋HANS group six hours after surgery （P 〈 0.01）, and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased （P 〈 0.05）.CONCLUSION： The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.
文摘Objective: The aim of the study was to investigate advanced medical students' knowledge towards cancer pain management, and understand the effect of specialisms and duration of oncology rotation on the advanced medical students' cognitive level towards cancer pain management. Methods: Randomly selected the respondents from a medical school in Wuhan, China. The educational background of the respondents should belong to one of these conditions: (1) clinical master degree candidate; (2) clinical doctor degree candidate; (3) the sixth or seventh year of clinical medicine for seven years. The respondents should also spend more than one year on internship. The self-developed questionnaire papers were distributed to respondents in the unit of dorms selected randomly and recovered them immediately after they're finished. The categori- cal data were expressed at the form of frequency (rate or constituent ratio). Chi-square test was required only as needed. Results: The survey was anonymous. We distributed 300 papers, recovered 300 papers and weeded out 8 invalid papers. Finally there were 292 valid papers, and the valid recovery rate was 97.3%. The 96.7% of oncological medical students and 47.6% non-oncological medical students relied on patients' description for cancer pain assessments; 90.0% of oncological medical students and 53.0% of non-oncological medical students prescribed strong opioid drugs firstly for patients suffering severe cancer pain; only 24.1% of non-oncological medical students recognized that pethidine was not safe and effective to treat cancer pain, which was much lower than oncological medical students (90.0%); 73.3% of oncological medical students and 28.9% of non-oncological medical students had the correct impression of drug addiction; 85.5% of non-oncological medi- cal students worried about the drug addiction, while 60.0% of oncological medical students worried about the strict control over opioid. In respect of the details of cancer pain management, only 66.7% of oncological medical students recognized that there was no upper limit of opioid prescribed clinically, and 16.3% of oncological medical students recognized that there was no psychological dependence if patients took opioid orally. The 69.8% of the students from no-less-than-two-week group relied on patients' description for cancer pain assessments, 76.7% prescribed strong opioid drugs firstly for patients suffer- ing severe cancer pain, 69.8% recognized that pethidine was not safe and effective to treat cancer pain, and 55.8% had the correct impression of drug addiction. All of the data were higher than that in no-rotation group and that in less-than-two-week group. The 51.2% of the students from no-less-than-two-week worried about drug addiction, which was the lowest of all. Conclusion: The cognitive level of advanced medical students towards cancer pain management is so low that it could not satisfy the clinical requirement, especially for the non-oncological medical students and the students spending little time on oncology rotation. Though the oncological medical students know something about cancer pain treatment, they know little about the details.
文摘Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar,Cross River State,Nigeria.Materials and Methods:A descriptive cross-sectional design was used for the study.The study was rooted in Katherine Kolcaba’s Comfort theory.Totally,67 participants were recruited for the study using the purposive sampling technique.A self-made structured questionnaire was used to obtain participants’information on knowledge,utilization,and predictors of nonpharmacological pain relief measures.Results:Although 41(61.2%)of the participants had knowledge about nonpharmacological pain relief measures,few did not know some of the cognitive-behavioral and environmental measures in labor pain management.There was 35.8%(24/67)for utilization of cognitive-behavioral measures and 55.2%(37/67)for psychological/emotional measures for labor pain management by respondents,respectively.Fifty(74.6%)of respondents agreed that predictors such as lack of knowledge,lack of updates and training,work experience,best practice guidelines,and equipment were hindrances to utilization.There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures(r=0.6,P<0.05).Conclusion:The utilization of nonpharmacological measures for labor pain management is low,thus it is recommended that frequent education,training updates on effective labor pain management,provision of clinical guidelines on labor pain management,and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.
文摘Neonatal pain management is an important issue which should have great attention.More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination,heel stick,and so on,and it will result in shortterm and long-term outcomes.So it is very important to manage neonatal pain.This article summarized some non-pharmaceutical interventions,including sucrose or glucose,non-nutritional sucking(NNS),breastfeeding,facilitated tucking(FT),kangaroo mother care(KMC),swaddling,heel warming,sensorial saturation(SS),and music therapy,which showed obvious effects for neonatal pain.In addition,this article summarized the progress of neonatal pain intervention in various countries and showed that many countries have not paid enough attention to this problem,while some countries have carried out promotion programs for neonatal pain management which give some clinical enlightenment to our country that we need to pay more attention to this problem.
