pain-relief-20.matches: pain relief
Home epidural analgesic infusion for non-cancer pain.

Ploughe B.

Pain Service Consultants, Inc., Canal Winchester, Ohio 43110, USA.

Continuous epidural analgesic infusion is widely recognized to be helpful for pain relief in the patient with cancer pain, but it can be as beneficial for the patient with non-cancer pain. Cancer pain patients have been offered long-term epidural infusion for relief of chronic pain, but non-cancer pain patients have less frequently been provided the same opportunities for pain relief. Both patient outcome and cost-effectiveness must dictate treatments offered as alternatives to long-term use of oral or injectables, nonsteroidal anti-inflammatories and muscle relaxants. It is necessary for nurses practicing in pain management and home health settings to understand the anatomy, neuropharmacology and nursing implications in order to effectively care for this growing population of patients. Epidural infusion is a safe and effective route of pain relief if the medical criteria as been met for choosing the patients receiving the treatment, and if the caregivers understand the treatment and expected outcomes. This article discusses anatomic considerations in drug selection, physiology, patient selection, neuropharmacology and patient care for epidural infusion. This article is designed to assist the nurse in accomplishing the patient and physician goals in this treatment modality for chronic non-cancer pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7499931&dopt=Abstract pain, pain medicine, pain relief



pain-relief-20.matches: pain relief
Cancer pain management in the hospice setting.

Manion JC.

Pain relief for the cancer patient in the hospice setting is almost always achievable. Cancer pain is caused by tumor growth and by psychosocial and spiritual factors. Opioid drugs are the mainstay of effective treatment. Morphine is the opioid drug of choice. Although tolerance to opioids occurs, tumor growth is the usual reason for escalating opioid dose. Addiction almost never occurs in the cancer patient with pain. These patients don't exhibit drug-seeking behavior or experience the psychic high seen in drug addicts. Nonsteroidal anti-inflammatory drugs and adjuvant analgesics are synergistic with opioids in providing analgesia and allow lower opioid doses and fewer side effects. Ten to 15 percent of hospice patients will require regional anesthesia for pain relief. The hospice team of physicians, nurses, social workers, chaplains, aides, and volunteers is more effective than any single health care provider in achieving optimal pain relief and comfort.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7534376&dopt=Abstract pain, pain medicine, pain relief



pain-relief-20.matches: pain relief
Shaping attitudes to postoperative pain relief: the role of the acute pain team.

McLeod GA, Davies HT, Colvin JR.

Department of Anesthetics, Ninewells Hospital and Medical School, Dundee, Scotland.

Postoperative pain relief is often inadequate. Ignorance and misconceptions about opioids by ward staff contribute to this poor management. The introduction of acute pain teams has done much to improve pain relief for patients. It may also have contributed to changes in attitudes and knowledge of medical and nursing staff. We questioned 48 doctors and nurses on their knowledge and beliefs about postoperative pain relief. Staff members were questioned on two units, one with access to an acute pain team and one without. Over half those on the unit using traditional postoperative care thought patients did not receive adequate pain relief (58%). In comparison, only one respondent from the unit with the pain team thought this was the case (P < 0.001). More staff members that had experience of patient-controlled analgesia (PCA) were optimistic about its benefits than those in the unit with no experience; they were also less concerned about possible side effects. Only one respondent on the unit using PCA thought it carried a risk of drug dependence, compared to over half (55%) of those on the unit with no experience in this technique (P < 0.001). Over two-thirds of staff familiar with PCA thought nursing workload had decreased. Acute pain teams have an important role in educating ward staff. The impact of establishing such teams on staff knowledge and attitudes needs further study to ensure that they can carry out this role most effectively.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7536228&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Effect of epidural analgesia on the primary cesarean section and forceps delivery rates.

Echt M, Begneaud W, Montgomery D.

Department of Obstetrics and Gynecology, Leonard Chabert Medical Center, Houma, LA 70363, USA.

OBJECTIVE: To determine the impact of introducing epidural analgesia for labor pain relief on the primary cesarean and forceps delivery rates. STUDY DESIGN: The control group consisted of 1,720 women who delivered on a charity hospital service between September 1, 1992, and August 31, 1993; epidural analgesia was not available for this cohort of patients. The study group consisted of 1,442 patients who delivered on the same service between September 1, 1993, and August 31, 1994; elective epidural analgesia for labor pain relief was available for this cohort of patients. A computerized obstetric database was analyzed to compare the two groups regarding demographics, parity, pregnancy complications, labor characteristics, type of delivery, low birth weight incidence and five-minute Apgar scores. RESULTS: The two groups were similar with respect to demographics and pregnancy complications. No control group patient received epidural analgesia for labor pain relief; 734 of 1,285 (57%) laboring patients in the study group elected epidural analgesia for pain relief. The primary cesarean delivery rate for the control group was 9.6% and for the study group 11.0% (not statistically significant). The control group had 34 (2.0%) forceps deliveries and the study group, 88 (6.1%), for a statistically significant difference. There were significantly more vaginal births after cesarean in the study group (42 vs. 26). CONCLUSION: Epidural analgesia was not associated with an increase in the primary cesarean delivery rate but was associated with an increase in the operative vaginal delivery rate.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10948466&dopt=Abstract pain, pain medicine, pain relief



pain-relief-20.matches: pain relief
Treatment of renal colic by desmopressin intranasal spray and diclofenac sodium.

el-Sherif AE, Salem M, Yahia H, al-Sharkawy WA, al-Sayrafi M.

Department of Urology, Hamad Medical Corporation, Doha, Qatar, Arabian Gulf.

The vasopressin analogue, 1-desamino-8-arginine vasopressin (desmopressin), is a potent antidiuretic without the pressor effects of vasopressin. A total of 18 patients with acute renal colic due to stone disease received 40 microgramsf1p4mopressin intranasal spray with encouraging results. There was a significant decrease in the colic pain intensity from an initial mean visual analogue score of 67 +/- 17 mm. to 39 +/- 36 mm. within 30 minutes (p < 0.001). Eight patients (44.4%) had complete pain relief within 30 minutes of administering intranasal desmopressin spray. Nine of 10 patients who required intramuscular diclofenac sodium achieved complete pain relief within another 30 minutes. In other words, when intranasal desmopressin spray was administered before diclofenac sodium, 94.4% of the patients achieved complete pain relief and were discharged home. The mechanism of analgesic action of desmopressin in renal colic is uncertain. At the peripheral level, desmopressin may alleviate the acute renal colic through its potent antidiuretic effect or by relaxing the renal pelvic and ureteral smooth muscles. The central analgesic effect of desmopressin by stimulating the release of the hypothalamic beta-endorphin is proposed. We conclude that intranasal desmopressin spray can be used successfully in the treatment of renal colic. It may also replace prostaglandin synthetase inhibitors in treating renal colic with the advantage of avoiding the potential side effects. Further studies are needed to investigate whether the combination of desmopressin with analgesics or spasmolytic drugs offers competitive results compared with those achieved by prostaglandin synthetase inhibitors in the treatment of renal colic.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7714949&dopt=Abstract pain, pain medicine, pain relief



pain-relief-20.matches: pain relief
Patient-controlled analgesia (PCA) with codeine for postoperative pain relief in ten extensive metabolisers and one poor metaboliser of dextromethorphan.

Persson K, Sjostrom S, Sigurdardottir I, Molnar V, Hammarlund-Udenaes M, Rane A.

Department of Clinical Pharmacology, Akademiska Hospital, Uppsala, Sweden.

Postoperative pain relief with codeine was evaluated in 11 women undergoing hysterectomy. Patient-controlled analgesia (PCA) was used to administer codeine. After the study the patients were phenotyped with respect to the O-demethylation of dextromethorphan (cytochrome P4502D6 polymorphism). Ten were extensive metabolisers and one a poor metaboliser. There was a nine-fold variation in the minimum plasma concentration of codeine consistent with pain relief (40-350 ng ml-1). Two patients did not experience any effect of codeine, one of whom was a poor metaboliser of dextromethorphan, confirmed by genotyping. In the other nine patients the effective dose of codeine varied from 4.8-25.3 mg h-1.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7742159&dopt=Abstract pain, pain medicine, pain relief



pain-relief-20.matches: pain relief
Localization of specific joint causing hindfoot pain: value of injecting local anesthetics into individual joints during arthrography.

Mitchell MJ, Bielecki D, Bergman AG, Kursunoglu-Brahme S, Sartoris DJ, Resnick D.

Department of Radiology, Victoria General Hospital, Halifax, N.S., Canada.

OBJECTIVE. The purpose of this study was to evaluate the utility of selective injection of local anesthetic into hindfoot articulations for localizing the source of posttraumatic pain and to compare clinical response with the severity of degenerative change in the various articulations evident on plain radiographs or CT scans. SUBJECTS AND METHODS. Anesthetic arthrography was performed in 18 patients with posttraumatic hindfoot pain. In all, 32 joints were assessed: 15 talocalcaneonavicular, 11 subtalar, five ankle, and one calcaneocuboid. Following intraarticular injection of a mixture of equal amounts of meglumine diatrizoate 60%, lidocaine 1%, and bupivacaine 0.25%, patients were asked to grade the degree of pain relief they experienced on a scale from 0% to 100%. The degree of degenerative changes seen on preliminary radiographs and CT scans was graded blindly and retrospectively by an experienced musculoskeletal radiologist using a 3-point scale (grade 0 indicated a normal joint, grade 1 indicated mild to moderate degenerative change, and grade 2 indicated severe degenerative change). The value of findings on both routine radiographs and CT scans as predictors of the degree of symptomatic relief obtained from specific joint injections was determined. Arthrodesis was performed in nine patients on the basis of the results of anesthetic injections. RESULTS. The degree of pain relief experienced after intraarticular injection of anesthetic correlated with the severity of degenerative change as assessed by routine radiography in 15 of 32 joints and as assessed by CT in eight of 18 joints. In 14 of 32 joints assessed by routine radiography and in seven of 18 joints assessed by CT, the amount of pain relief achieved by anesthetic arthrography was less than that predicted by imaging evidence of degenerative disease. In five of 32 joints judged normal on plain film radiographs, significant pain relief was experienced following anesthetic injection, resulting in a change in the proposed surgical procedure. Long-term follow-up indicated satisfactory results in eight of the nine patients in whom arthrodesis was performed. CONCLUSION. Selective intraarticular anesthetic injections afford a direct method of confirming the site of hindfoot pain and may aid in surgical planning, because plain film radiography or CT may underestimate or poorly indicate the most symptomatic articulations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7754895&dopt=Abstract pain, pain medicine, pain relief