Use Of Analgesic Medications Research Articles

The impact of a quality improvement project to standardize pain, agitation, and withdrawal assessments on the use of morphine and midazolam in the Pediatric Intensive Care Unit.

This study aims to assess the impact of a quality improvement initiative to increase assessments of pain, agitation, and iatrogenic withdrawal syndrome, on the use of sedative and analgesic medication in a pediatric intensive care unit. This is a retrospective pre and post, observational, quality improvement study conducted in an 18-bed medical-surgical-cardiac, tertiary intensive care unit. We included patients consecutively admitted from October 1 to March 31 (pre-period 2015-2016, post-period 2016-2017) who were mechanically ventilated beyond 48hours. A multidisciplinary team, including a family advisor, implemented the following interventions using rapid "Plan-Do-Study-Act cycles:" (a) standardized pain and sedation assessments, (b) standardized sedation goal setting, and (c) non-pharmacological strategies to manage pain and agitation. We did not implement any specific sedation protocol. We used audit and feedback to reinforce change. The post-intervention phase started once sedation scores were documented q12h for >60% of patients. The groups (n=45 per group) were similar regarding demographics, severity of illness, and mechanical ventilation duration, but different in length of intensive care stay. The cumulative dose of midazolam equivalent was significantly lower in the post-intervention period (3.71 vs 2.65mg/kg/mechanical ventilation day, P=0.009, 95% CI: -1.12 (-1.89, -0.31)). Morphine equivalent usage went from 3.51 to 2.57mg/kg/mechanical ventilation day (P=0.066, 95% CI: -0.67 [-1.44, 0.05]). There were no significant pre-post-differences in the use of other sedative agents, rates of iatrogenic withdrawal syndrome or severe pain, nor medication cost. Implementation of a multifaceted QI project was successful at increasing standardized assessments of pain and agitation, and was associated with a significant reduction in midazolam use. We also observed a decrease in morphine use without increasing rates of severe pain. Incidence of iatrogenic withdrawal syndrome and cost were unchanged.

Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews.

Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews.

Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities

Gaps in pain management, including discontinuity in analgesic medication prescribing, frequently complicate transitions from hospital to skilled nursing facilities (SNFs) for patients with dementia. The objective of the current study was to examine analgesic medication use and prescribing patterns in the last 48 hours of hospitalization and upon discharge to SNF among stroke and hip fracture patients with dementia. Of 318 patients who received an analgesic medication within the last 48 hours of hospitalization, 23% experienced potentially abrupt discontinuations upon discharge. These rates varied by medication, with acetaminophen with codeine (27%), hydromorphone (19%), and acetaminophen with hydrocodone (19%) having the highest rates of potentially abrupt discontinuations. Conversely, 38% of patients experienced potentially abrupt additions of an analgesic medication upon discharge. Findings suggest that changes to analgesic regimens prior to and upon discharge may be common practice, potentially hindering care continuity and pain control during transitions. [Res Gerontol Nurs. 2019; 12(2):61-69.].

Associations Among Sleep Latency, Subjective Pain, and Thermal Pain Sensitivity in Gynecologic Cancer.

Pain is common among women with gynecologic cancer and contributes to depressed mood, sleep disturbances, and likelihood of future chronic pain. Little is known about how psychosocial factors are associated with central sensitization of pain in gynecologic cancer. This study examined relations among depressive symptoms, sleep, subjective pain, and aftersensation pain (a proxy for central sensitization of pain) in gynecologic cancer. Participants were 42 women (mean age [SD] = 59.60 [10.11] years) enrolled in a randomized clinical trial examining psychological intervention effects on sleep, pain, mood, and stress hormones/cytokines in gynecologic cancer. Six to eight weeks after surgery, participants completed an assessment of depressive symptoms, sleep, and subjective pain and a temporal summation of pain protocol via quantitative sensory testing (QST). Controlling for recent chemotherapy, history of chronic pain, and analgesic medication use, regression analyses revealed that longer sleep onset latency (SOL; B = 3.112, P = 0.039, bias-corrected and accelerated (BCa) 95% confidence interval [CI] = 0.371 to 6.014) and greater sensory pain (B = 0.695, P = 0.023, BCa 95% CI = 0.085 to 1.210) were associated with greater aftersensation pain at 15 seconds. Greater sensory pain scores were associated with greater aftersensation pain at 30 seconds (B = 0.286, P = 0.045, BCa 95% CI = 0.008 to 0.513). Depression was not associated with aftersensation pain. The overall models accounted for 44.5% and 40.4% of the variance in aftersensation pain at 15 and 30 seconds, respectively. Conclusions. Longer SOL and higher subjective sensory pain were related to greater aftersensation of experimentally induced pain in women postsurgery for gynecologic cancers. Interventions that improve sleep and subjective sensory pain during the perisurgical period may reduce risk for central sensitization of pain.

THE EFFECTS OF MUSIC INTERVENTION ON WOMEN’S ANXIETY BEFORE AND AFTER CESAREAN DELIVERY: A Randomized Controlled Trial

ABSTRACT:Objective: To assess effect of perioperative music intervention on maternal anxiety levels, physiologic metrics, and medication use for anxiety, nausea and pain during and after scheduled cesarean section. Methods: Women assigned to music intervention group were compared against controls. Physiologic metrics, medication requirements, and STAI scores were assessed for all participants. Results: 50 women were enrolled, assigned to either music intervention (n=25) or control (n=25) and analyzed. Physiologic metrics were similar between groups. Antiemetic, anxiolytic, and analgesic medication use intraoperatively and postoperatively were not significantly different. State and Trait scores by the STAI did not vary significantly by intervention (p=0.09). STAI scores before and after procedure demonstrated the least change for the intervention group (r=0.6) when compared to controls (r=0.2; p<0.05).Conclusion: Contrary to studies with formal music therapy, our data do not support use of patient-selected music as an intervention to reduce maternal anxiety or need for analgesics, anxiolytics, or antiemetics with scheduled cesarean section.

FDA takes important steps to encourage appropriate and rational prescribing of opioids through final approval of new safety measures governing the use of immediate-release opioid analgesic medications

FDA takes important steps to encourage appropriate and rational prescribing of opioids through final approval of new safety measures governing the use of immediate-release opioid analgesic medications

Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants-SAFER Study VI.

Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use. Cross-sectional study. 21.1-km and 56-km races. Seventy-six thousand six hundred fifty-four race entrants. Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history. Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)]. Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases. 12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.

Association Between Trapezius Muscle Tenderness and Tension-Type Headache in Female Office Workers: A Cross-sectional Study

ObjectiveThe purpose of the study was to determine the association between trapezius muscle tenderness and tension-type headache among female office workers. MethodsThrough a questionnaire survey, 256 female office workers with tension-type headaches reported the level of palpable tenderness (“no,” “some,” or “severe tenderness”) in the trapezius muscle. The number of days with headache (“0-7,” “8-14,” or “>14”), intensity (“low,” “moderate,” or “high”), duration of headache (“<8 hours per day,” “>8 hours per day,” and “all day”), and use of analgesic medications were reported. Odds ratio (OR) for tenderness in the trapezius muscle (“no/some” vs “severe tenderness”) as a function of days with headache, intensity of headache, duration of headache, and use of analgesic medications were calculated using a binary logistic regression controlling for age and body mass index. ResultsAfter adjustments for confounders, a strong association was found between the level of trapezius muscle tenderness and intensity of headache (moderate intensity, OR 2.45; 95% confidence interval [CI] 1.08-5.54; high intensity, OR 7.51 [95% CI 2.65-21.29]) and days with headache (>14 days, OR 4.75 [95% CI 1.41-15.89]). No association was observed for duration of headache or use of analgesic medications. ConclusionsFor the participants studied, there was a strong association between trapezius muscle tenderness and the level of intensity and the number of days with a headache among female office workers. No association was seen for duration of headaches or use of analgesic medications.

Ultrasound-guided, percutaneous, needle technique, A1-pulley release for trigger finger

Trigger finger is a common cause of hand pain and disability and an A1-pulley dividing, percutaneous release is a definitive treatment for advanced stage disease. High-resolution, musculoskeletal ultrasonography provides clear visualization of the A1-pulley and flexor tendon, however, the evidence to support ultrasonographic guidance of this procedure is scarce. This study aim to evaluate the results of ultrasound (US)-guided, percutaneous, needle technique, annular, A1-pulley release for trigger finger (TF); specifically identifying whether this minimally-invasive procedure had low complication rates and enables early functional recovery. Single center, prospective cohort study of consecutive patients who were > 20 years of age, had grade II TF or higher for at least 4 months, and were unresponsive to conservative treatment. Patients with chronic connective tissue disease, rheumatoid arthritis, previous TF surgery, pregnancy, or bleeding risks were excluded. The procedure was an US-guided percutaneous A1-pulley release using needle technique. Outcome measures at 1 week post-surgery included; recovery time, pain level and duration, use of analgesic medications, time to normal activity of affected TF, and subject satisfaction for cosmesis and overall results. Surgical complications were monitored for 6 months. Thirty-nine fingers from 33 patients who received US-guided, percutaneous, A1-pulley release using needle technique were included in the analysis. Mean operative time was 6.17 (SD = 1.70) minutes. Median postoperative pain duration, use of analgesic medications, and recovery time to normal activity were 1.0 (IQR = 0–2), 0.5 day (IQR = 0.5–1), and 2 days (IQR = 1–2), respectively. Mean subject satisfaction scores for wound appearance and overall treatment were 9.87 and 9.61, respectively. Only one patient had an incomplete release and no severe complication were observed. US-guided, percutaneous, A1-pulley release with needle technique was an effective treatment for TF, with high levels of overall satisfaction and no significant complications.

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones

Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage. To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients. We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase). Participants were followed for 90 days. The first phase was conducted at a single US emergency department; the second phase was conducted at 6 US emergency departments. Adult patients were eligible to participate if they presented with a symptomatic urinary stone in the ureter less than 9 mm in diameter, as demonstrated on computed tomography. Participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days. The primary outcome was stone passage based on visualization or capture by the study participant by day 28. Secondary outcomes included crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention, and repeated emergency department visit for urinary stones. The mean age of 512 participants randomized to tamsulosin or placebo was 40.6 years (range, 18-74 years), 139 (27.1%) were female, and 110 (22.8%) were nonwhite. The mean (SD) diameter of the urinary stones was 3.8 (1.4) mm. Four hundred ninety-seven patients were evaluated for the primary outcome. Stone passage rates were 50% in the tamsulosin group and 47% in the placebo group (relative risk, 1.05; 95.8% CI, 0.87-1.27; P = .60), a nonsignificant difference. None of the secondary outcomes were significantly different. All analyses were performed according to the intention-to-treat principle, although patients lost to follow-up before stone passage were excluded from the analysis of final outcome. Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised. ClinicalTrials.gov Identifier: NCT00382265.

Fixed Time Interval Compared With On-Demand Oral Analgesia Protocols for Postcesarean Pain: A Randomized Controlled Trial

(BJOG. 2017;124(7):1063–1070) Effective postcesarean analgesia is important as untreated pain can impair maternal bonding with her infant and decrease the rate of successful breastfeeding. Postoperative pain can also lead to decreased ambulation, which is associated with an increased risk of thromboembolic events and other postoperative complications. Although many options for postcesarean pain treatment are available, the use of oral analgesic medications is simple and may promote maternal mobilization. However, the data are limited and inconclusive regarding the superiority of dosing oral analgesics using a fixed time interval or on patient demand. This open-label, parallel-group, randomized controlled trial aimed to compare efficacy, safety, and patient satisfaction when administering a combination of oral pain relievers on patient demand versus a fixed time interval for the treatment of postcesarean pain in the first 48 hours following surgery.

Advances in Clinical Diagnosis and Management of Chikungunya Virus Infection

In this review, we attempt to give the reader an update on clinical diagnosis, management, and treatment of Chikungunya virus (CHIKV) infection regarding the course of the disease and the role of clinical laboratory. CHIKV infection evolves through three phases: acute, sub-acute, and chronic. Protocol for patient assessment and management should be in agreement with each phase requirements. Despite its benignity, CHIKV infection has shown an increase in severe cases during recent outbreaks. Among the most affected group are neonates, elderly population, and patients with co-morbidities. Furthermore, since CHIKV geographical distribution and clinical spectrum overlaps with other arboviruses, differential diagnosis becomes crucial for physicians to ensure good management and treatment for patients. In this review, we describe and compare the main symptoms, complications, and risk groups for CHIKV, Dengue (DENV), and Zika (ZIKV) infections, regarding key features will guide to an accurate diagnosis. CHIKV is an emergent and reemergent arbovirus that arrived in the Americas in 2014, causing thousands of infections. The acute febrile phase is similar to that of dengue but with a higher proportion of debilitating arthralgia that can persist for months or even years after infection. Severe forms of CHIKV infection can lead to chronic polyarthralgia, neurologic symptoms, or multiorgan failure. Treatment of CHIKV infection is mainly focused on supportive care, which includes the use of analgesic and anti-inflammatory medication, rehydration, and rest.

Personality traits and the use of manual, alternative, and mental healthcare services and medication in Norwegian musicians

To investigate the association between personality traits and use of analgesic medication, anti-depressants and sedatives, mental health services, manual and alternative healthcare services among Norwegian musicians, 1607 musicians from the Norwegian Musicians Union answered an online questionnaire. Based on logistic regression analysis, adjusting for age, sex, education and general health, we investigated a possible dose-response relationship between the personality traits neuroticism, extraversion, openness to experience, agreeableness and conscientiousness and the use of these services and types of medication.As hypothesized, Neuroticism was positively associated with excess use of all types of the before mentioned health care services and medications. A higher score on openness to experience was positively associated with use of alternative and complementary healthcare services. Contrary to our expectations, extraversion was positively associated with the use of mental health care services and unrelated to other type of health care and medication use. Conscientiousness was negatively associated with the use of mental health care services.The results suggest that the relationship between personality and healthcare use cannot be attributed to occupation alone. The findings address the importance of differentiating behavior outcome (i.e. the use of health care services) from other outcome like symptom reporting or attitudes towards help seeking.

Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units

Background: The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. Objective: This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Methods: Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Results: Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Conclusions: Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

Anesthetic blocks in the elderly in the treatment of headache

Introduction: Headache in elderly patients is a frequent complaint, with atypical clinical features in this group. In addition, treatment options are limited, considering the presence of other comorbidities and daily medications in use. The possibility of anesthetic blocks would be an interesting option for this group of patients. Objectives: This study aimed to describe and analyze, in a single center, elderly patients who were treated with anesthetic blocks for headache. The main types of headache, indications of peripheral blocks, blocked points and, adverse effects response to treatment were also assessed. Methods: The study was conducted from the review of medical records in a Neurological Clinic. Patients with headache diagnosis, with 50 years old and older, who received anesthetic blocks were included. Diagnosis of headache, characteristics, intensity and frequency, associated comorbidities, instituted treatments, including anesthetic blocks and botulinum toxin application, as well as therapeutic response and presence of adverse effects were described. Results: Medical records from 2013 to 2017 were reviewed (n= 4,106). Of these, 785 patients were treated for chronic pain with anesthetic blocks and 82 patients were elderly with headache, treated with anesthetic blocks. The mean age of the patients was 57.7 years (SD 7.89) and 65 (79.3%) were women. The main diagnosis of headache was migraine (41, 50%), cervicogenic headache (33, 40.2%), temporomandibular dysfunction (11, 13.4%), trigeminal-autonomic headache (4, 4.8%) and tension-type headache (2, 2.4%). The frequency of pain was 24.3 days/month (SD 9.2) and mean pain intensity was 9.3 (0-10). The abusive use of analgesic medications was described in 17 (20.7%) patients. The main anesthetic blocks were major and minor occipital nerves (62, 75.6%) and muscular trigger points (19, 23.2%). Botulinum toxin application was performed in 6 patients (7.3%). The average number of blocks was 2.74 (SD 2.38) per patient. There was a total improvement of the symptoms in 52 (63.4%) and partial improvement in 22 (26.83%). The mean frequency of pain after treatment was 4.3 days/month (SD 6.09). There were no adverse events related to the procedures. Conclusion: The use of anesthetic blocks in the elderly in the treatment of headache was considered safe and effective as a therapeutic option.

Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome

Background: Pain control after breast reconstruction with Deep Inferior Epigastric Perforator (DIEP) often requires intravenous narcotic analgesia and inpatient hospitalization. Intrathecal morphine (ITM) administration analgesia is increasing in popularity because it decreases the use of intravenous analgesic medications and offer comparable pain relief with less systemic side effects. Questions/purposes: The aim of this retrospective study was to evaluate the effect of intrathecal morphine on postoperative morbidity of breast reconstruction by Deep Inferior Epigastric Perforator flap and compare it with intravenous narcotic analgesia. Methods: 269 patients underwent immediate or delayed DIEP reconstruction after mastectomy, by the same surgeon, at Jules Bordet Institute. Patients receiving ITM analgesia (300 μ) were matched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in the same years by the same surgeon. Differences in peri- and postoperative complications across the two groups were assessed. Results: The two groups were comparable in terms of demographic characteristics and factors of morbidity. Intraoperative variables were not statistically different between the groups except for intraoperative blood loss (P = 0.0001), transfusion (P = 0.0001) and Intraoperative liquid requirement (p = 0.0001). Intra and postoperative blood pressure were lower in ITM group (p < 0.05). Patients in ITM group showed lower postoperative analgesia requirement (P < 0,0001), less respiratory complications and less acute respiratory failure (P = 0,003 and P = 0,004, respectively). No statistically significant differences in the length of hospital stay (LOS) were noted Conclusion: We found that intrathecal morphine analgesia was associated with less blood loss and fluid administration, better postoperative pain control, and less respiratory complications with an acceptable security profile than intravenous narcotic analgesia. Clinical relevance: This study suggests that using intrathecal morphine may result in less blood loss and blood transfusion, better postoperative pain control, and less respiratory complications.

Urine Leak Following Kidney Transplantation: An Evidence-based Management Plan

Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. On-going urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life, reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.

Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial.

Among women in labour, does sequential application of non-pharmacological interventions relieve labour pain, shorten labour, and delay pharmacological analgesia use? Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Eighty women admitted in labour at the end of a low-risk pregnancy. Participants in the experimental group received three interventions for up to 40minutes each in particular stages of labour: exercise on a Swiss ball at 4 to 5cm of cervical dilation; lumbosacral massage at 5 to 6cm dilation; and a warm shower at >7cm dilation. Participants in the control group received usual maternity unit care. Participants in both groups were encouraged to try not to avoid or delay use of pharmacological analgesia. Pain severity was reported on a visual analogue scale. Maternal and neonatal data were collected from official birth records. Satisfaction with care was recorded with a questionnaire. Some participants took analgesic medication before the study was complete, so pain was analysed with a last observation carried forward approach. In this analysis, the experimental group had significantly lower pain severity immediately after: exercises (MD 24mm, 95% CI 15 to 34), massage (14mm, 95% CI 4 to 25), and showering (17mm, 95% CI 5 to 29), which allowed delayed and reduced use of analgesic medication. Other significant benefits included: faster expulsion (MD 18minutes, 95% CI 5 to 30), improved neonatal status, and higher maternal satisfaction. No adverse effects were identified. This sequence of non-pharmacological interventions significantly reduced labour pain from 4cm to beyond 7cm of cervical dilation, as reflected in decreased and delayed use of analgesic medication. Women in labour could be encouraged to use these interventions, especially if they seek to minimise or delay use of analgesic medication. NCT01389128. [Gallo RBS, Santana LS, Marcolin AC, Duarte G, Quintana SM (2018) Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial. Journal of Physiotherapy 64: 33-40].

Musicians are High Consumers of Complementary and Alternative Healthcare Services: The Norwegian Musicians’ Health Project

To estimate the use of analgesic medication and manual and alternative healthcare services among Norwegian musicians compared to the general workforce. 1,607 musicians from the Norwegian Musicians' Union answered an online questionnaire about demographic characteristics, use of healthcare services, and use of medication. They were compared to a sample of the Norwegian workforce (n=2,610) from the Norwegian survey of level of living. Based on logistic regression analysis, adjusting for age, sex and education, we compared the self-reported use of different forms of healthcare services and medication in musicians to the general workforce. Musicians reported a 2-fold increased use of manual (OR 1.87, CI 1.40-2.33) and complementary and alternative healthcare services (OR 2.58, CI 2.07-3.21) compared to the general workforce. Higher proportions of use of analgesic medication (OR 1.52, CI 1.21-1.89) were also evident in musicians. Musicians, as a whole, consistently reported higher use of manual and alternative healthcare services and use of analgesic medication than the general Norwegian workforce.

Analgesic Consumption Following Outpatient Carpal Tunnel Release.

Few studies have examined the consumption of prescribed opioid medications after elective outpatient surgery. A better understanding of opioid consumption after elective upper-extremity surgery may lead to improved prescribing practices, decreased costs, and less leftover medication available for potential misuse. The goal of this study was to evaluate pain control and quantify the amount of leftover pain medication after outpatient carpal tunnel release. We performed a prospective study of patients scheduled for outpatient carpal tunnel surgery. All patients had failed nonsurgical treatment and had an electromyelogram/nerve conduction study confirming the clinical diagnosis. All patients were encouraged to remove the dressing on the first postoperative day. A total of 56 patients were initially enrolled in the study; 7 did not meet the inclusion criteria, which left 49 patients who completed the study. Average age was 57 years; 66% of patients were female. Information collected included analgesic prescribed, number of tablets consumed, and number of tablets remaining. Use of postoperative orthoses, complications, use of other analgesic medications, and reasons for not taking the prescribed analgesics were recorded. Paracetamol with codeine and paracetamol with tramadol accounted for all prescriptions. Patients most frequently were given a prescription for 40 tablets. Average number of tablets consumed was 10 (range, 0-40 tablets). More than half of patients consumed fewer than 2 tablets. The average number of postoperative days of analgesic consumption was 2 (range, 0-7 days). Overall 1,531 tablets were leftover from the entire cohort. This study demonstrates that excess prescription analgesics are being prescribed after carpal tunnel surgery. Therapeutic IV.