Analgesia For Pain Management Research Articles

Cannabinoid Analgesia in Postoperative Pain Management: From Molecular Mechanisms to Clinical Reality.

Postoperative pain (POP) is a challenging clinical phenomenon that affects the majority of surgical patients and demands effective management to mitigate adverse outcomes such as persistent pain. The primary goal of POP management is to alleviate suffering and facilitate a seamless return to normal function for the patient. Despite compelling evidence of its drawbacks, opioid analgesia remains the basis of POP treatment. Novel therapeutic approaches rely on multimodal analgesia, integrating different pharmacological strategies to optimize efficacy while minimizing adverse effects. The recognition of the imperative role of the endocannabinoid system in pain regulation has prompted the investigation of cannabinoid compounds as a new therapeutic avenue. Cannabinoids may serve as adjuvants, enhancing the analgesic effects of other drugs and potentially replacing or at least reducing the dependence on other long-term analgesics in pain management. This narrative review succinctly summarizes pertinent information on the molecular mechanisms, clinical therapeutic benefits, and considerations associated with the plausible use of various cannabinoid compounds in treating POP. According to the available evidence, cannabinoid compounds modulate specific molecular mechanisms intimately involved in POP. However, only two of the eleven clinical trials that evaluated the efficacy of different cannabinoid interventions showed positive results.

Antinociceptive effects of α2/α3-subtype selective GABAA receptor positive allosteric modulators KRM-II-81 and NS16085 in rats: behavioral specificity.

Recent studies suggest that amongst the GABAA receptor subtype heterogeneity, α2/α3 subunits of GABAA receptors mediate pain processing. Therefore, α2/α3-subtype selective GABAA receptor positive allosteric modulators (PAMs) may be candidate analgesics. Antinociceptive effects of α2/α3-subtype selective GABAA receptor PAMs have been reported, but the behavioral effects of these compounds have not been systematically evaluated. This study examined the behavioral effects of two α2/α3 subtype-selective GABAA receptor PAMs, KRM-II-81 and NS16085, in male rats. The antinociceptive effects of KRM-II-81 and NS16085 were examined using rat models of inflammatory (complete Freund's adjuvant) and neuropathic pain (chronic constriction injury). The effect of KRM-II-81 on affective pain was measured using the place escape/avoidance paradigm (PEAP). Rate-response of food-maintained operant responding, horizontal wire test, and the spontaneous alternation T-maze, were assessed to study the side-effect profiles of KRM-II-81 and NS16085. The benzodiazepine midazolam was used as a comparator in these studies. KRM-II-81 and NS16085 attenuated mechanical allodynia but not thermal hyperalgesia in both pain states, and their effects were attenuated by the benzodiazepine receptor antagonist flumazenil. KRM-II-81 attenuated affective pain-related behavior in the PEAP test. In the operant responding procedure and horizontal wire test, only midazolam produced significant effects at the dose that produced maximal antinociception. In the T-maze assay, only midazolam significantly decreased the percentage of alternation at an antinociceptive dose. Thus, KRM-II-81 and NS16085 but not midazolam selectively produced antinociceptive effects. Collectively, these data suggest that α2/α3-subtype selective GABAA PAMs could be a novel class of analgesics and warrant further investigation. Significance Statement This study demonstrates that α2/α3-subtype selective GABAA PAMs KRM-II-81 and NS16085 produce selective antinociceptive effects devoid of sedation, myorelaxation, cognitive impairment in two rat models of persistent pain. Unlikely classical benzodiazepines, this study supports the development of α2/α3-subtype selective GABAA PAMs as safe and novel analgesics for pain management.

Latrodectus envenomation in Ethiopia.

Black widows, one of the few spiders that can sting humans with poison, are members of the spider genus Latrodectus and are well-known for the extraordinary potency of their neurotoxic venom. Latrodectism, a symptom marked by excruciating muscular pain, stomach pain, and diaphoresis after envenomation, is very typical. We described a black widow envenomation case that produced a significant reaction, including diaphoresis and excruciating pain throughout the left thigh that later spread to the lower leg, lower back, belly, and chest. Because of the patient's description of the spider that bit him and his typical clinical state, it was assumed that Latrodectus envenomation was the cause of his symptoms. The patient received 3days of observation in the ED while receiving opioid analgesic pain management and muscle relaxant treatment with diazepam. The patient's pain and symptoms were satisfactorily managed, and he was sent home. This case report will help further research be done in the area where it was reported to see if there are cases with similar presentations misdiagnosed as other illnesses. Finally, immediate pain relief is the most critical goal for all patients.

Postoperative Pain after Inguinal Hernia Repair Using the Tension-Free Lichtenstein Procedure: A Retrospective Study.

Inguinal hernia surgery is a constantly evolving field, with ongoing research efforts aimed at enhancing surgical techniques and outcomes for patients. This retrospective study conducted between 2015 and 2020 in the First Surgical Clinic of Craiova Emergency Clinical Hospital focused on the occurrence and characteristics of postoperative pain following inguinal hernia repair using the tension-free Lichtenstein procedure. A total of 178 patients were included in the study, with 16.85% reporting postoperative pain. The average pain intensity was 6.4 on a scale of 1 to 10. Patients described the pain as numbness, burning sensation, stinging, pressure, and tingling sensations. Notably, 50% of patients reported pain related to weather changes. While the study explored potential relationships between patient demographics, hernia type, and postoperative pain, no statistically significant associations were found. Approximately 20% of patients with postoperative pain reported adverse effects on their work, and 10% used analgesics for pain management. This study highlights the multifaceted nature of postoperative pain following inguinal hernia repair, emphasizing the need for further research to identify individual risk factors and adherence to international guidelines for hernia management. The findings also underscore the importance of effective pain management strategies to improve patient comfort and quality of life post-surgery.

LARYNGEAL MASK AIRWAY VERSUS ENDOTRACHEAL INTUBATION FOR ADENOIDECTOMY IN OUTPATIENT SURGERY - SINGLE CENTER EXPERIENCE.

Adenoidectomy with or without tonsillectomy remains one of the most routinely performed surgical procedures in children. The duration of the procedure is usually less than half an hour and is done in a day surgery setting. Airway management for adenoidectomy can be especially challenging as the airway is shared between the surgeon and the anesthesiologist. The gold standard for airway management is an endotracheal tube (ETT), even though there has been an increase in the use of laryngeal mask airway (LMA) over the past decade. This retrospective study investigated patient data collected over a 4-year period (2016 to 2020). Data included 210 cases in a day surgery setting. We analyzed the choice of airway device and use of neuromuscular blockers and analgesics for pain management. The use of LMA was noted in 67.62% while endotracheal intubation was performed in 32.38% of cases. LMA resulted in fewer respiratory complications compared to ETT (p=0.006). The need for neuromuscular blockers was also lower in the LMA group (p=0.01). There was no statistically significant difference in the intraoperative dose of opioid analgesia (p=0.09). Flexible LMA is a satisfactory alternative to endotracheal intubation for outpatient pediatric adenoidectomy.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Systemic glucocorticoids as an adjunct to treatment of postoperative pain after total hip and knee arthroplasty: A systematic review with meta-analysis and trial sequential analysis.

Postoperative analgesic effects of systemic glucocorticoids given as an adjunct to treatment are largely undetermined in alloplastic procedures. To investigate the beneficial and harmful effects of peri-operative systemic glucocorticoid treatment for pain after total hip arthroplasty (THA) or total knee arthroplasty (TKA). A systematic review of randomised clinical trials (RCTs) with meta-analyses, trial sequential analyses and GRADE. Primary outcome was 24 h intravenous (i.v.) morphine (or equivalent) consumption with a predefined minimal important difference (MID) of 5 mg. Secondary outcomes included pain at rest and during mobilisation (MID, VAS 10 mm), adverse and serious adverse events (SAEs). We searched EMBASE, Cochrane CENTRAL, PubMed and Google Scholar up to October 2021. RCTs investigating peri-operative systemic glucocorticoid versus placebo or no intervention, for analgesic pain management of patients at least 18 years undergoing planned THA or TKA, irrespective of publication date and language. We included 32 RCTs with 3521 patients. Nine trials were at a low risk of bias. Meta-analyses showed evidence of a reduction in 24 h cumulative morphine consumption with glucocorticoids by 5.0 mg (95% CI 2.2 to 7.7; P = 0.0004). Pain at rest was reduced at 6 h by 7.8 mm (95% CI 5.5 to 10.2; P < 0.00001), and at 24 h by 6.3 mm (95% CI 3.8 to 8.8; P < 0.00001). Pain during mobilisation was reduced at 6 h by 9.8 mm (95% CI 6.9 to 12.8; P < 0.00001), and at 24 h by 9.0 mm (95% CI 5.5 to 12.4, P < 0.00001). Incidence of adverse events was generally lower in the glucocorticoid treatment group. SAEs were rarely reported. The GRADE rated quality of evidence was low to very low. Peri-operative systemic glucocorticoid treatment reduced postoperative morphine consumption to an individually relevant level following hip and knee arthroplasty. Pain levels were reduced but were below the predefined MID. The quality of evidence was generally low. PROSPERO ID: CRD42019135034.

Clinical research and application of preemptive analgesia in dental treatment

Preemptive analgesia refers to the use of analgesics or regional nerve block in advance of nerve conduction changing or nerve remodeling caused by traumatic stimulation, so as to achieve better postoperative pain relief and to prevent postoperative pain hypersensitivity. Preemptive analgesia minimizes or prevents postoperative pain by reducing peripheral and central sensitization, which thereby limit the pain cascade. This paper briefly introduces the mechanism and methods of preemptive analgesia, as well as its application and research progress in the field of oral treatment. With the increased requirements for comfortable medical treatments and popularization of multimodal analgesia in pain management of oral surgery, preemptive analgesia will be more widely studied and applied in oral diagnosis and treatment.

Paeoniflorin alleviates CFA-induced inflammatory pain by inhibiting TRPV1 and succinate/SUCNR1-HIF-1α/NLPR3 pathway

BackgroundTreatment of chronic inflammatory pain remains a major goal in the clinic. It is thus of prime importance to characterize inherent pathophysiological pathways to design new therapeutic strategies and analgesics for pain management. Paeoniflorin (PF), a monoterpenoid glycoside from Paeonia lactiflora Pallas plants, possesses promising anti-nociceptive property. However, therapeutic effect and underlying mechanism of action of PF on inflammatory pain have not yet been fully elucidated. In this study, we aim to investigate the analgesic effect further and clarify its mechanism of action of PF on complete freund’s adjuvant (CFA)-evoked inflammatory pain. MethodsTwenty-four male mice were divided into 3 groups: sham, CFA, and CFA + PF groups (n = 8/group). Mice were treated with normal saline or PF (30 mg/kg) for 11 days. Footpad swelling (n = 8/group), mechanical (n = 8/group) and thermal hypersensitivity (n = 8/group) were measured to evaluate the analgesic effect of PF on CFA-injected mice. At the end of the animal experiment, blood and L4-L6 dorsal root ganglion neurons were collected to assess the therapeutic effect of PF on CFA-induced inflammatory pain. Next, hematoxylin and eosin, quantitative realtime PCR, ELISA, capsaicin and dimethyl succinate induced pain test (n = 8/group), motor coordination test (n = 8/group), tail flicking test (n = 8/group), pyruvate and succinate dehydrogenase assay (n = 6/group), immunohistochemical staining, were performed to clarify the action mechanism of PF on CFA-evoked inflammatory pain. Besides, the effect of PF on TRPV1 was evaluated by whole-cell patch clamp recording on primary neurons (n = 7). Finally, molecular docking further performed to evaluate the binding ability of PF to TRPV1. ResultsPF significantly relieved inflammatory pain (P < 0.001) and paw edema (P < 0.001) on a complete Freund adjuvant (CFA)-induced peripheral inflammatory pain model. Furthermore, PF inhibited neutrophil infiltration (P < 0.01), IL-1β increase (P < 0.01), and pain-related peptide substance P release (P < 0.001). Intriguingly, CFA-induced succinate aggregation was notably reversed by PF via modulating pyruvate and SDH activity (P < 0.01). In addition, PF dampened the high expression of subsequent succinate receptor SUCNR1 (P < 0.01), HIF-1α (P < 0.05), as well as the activation of NLPR3 inflammasome (P < 0.05) and TRPV1 (P < 0.05). More importantly, both capsaicin and dimethyl succinate supplementation obviously counteracted the pain-relieving effect of PF and TRPV1 (P < 0.01 or P < 0.001). ConclusionOur findings suggest that PF can significantly relieve CFA-induced paw swelling, as well as mechanical and thermal hyperalgesia. PF alleviated inflammatory pain partly through inhibiting the activation of TRPV1 and succinate/SUCNR1-HIF-1α/NLPR3 pathway. Furthermore, we found that PF exerted its analgesic effect without affecting motor coordination and pain-related cold ion-channels. In summary, this study may provide valuable evidence for the potential application of PF as therapeutic strategy for inflammatory pain treatment.

Intravenous analgesia versus thoracic epidural catheterization in moderately severe pancreatitis: A randomized controlled trial in a tertiary care health facility.

Objective: In this study we evaluated the two most commonly used methods for pain relief in acute pancreatitis i.e. epidural analgesia and I/V analgesia and compared the results. Study Design: Randomized Controlled Clinical Trial. Setting: Surgical Unit-1 of Holy Family Hospital, Rawalpindi. Period: June 2019 to June 2020. Material &amp; Methods: Patients presenting with acute pancreatitis with moderate severity were divided into groups A and B. In group A patients, epidural catheter was passed at T9-T10 level epidural space and they received 0.125% Bupivacaine injection every 4 hours, while group B patients received combination analgesia in the form of IV tramadol 100mg TDS and IV Toradol 30mg BD. Pain was assessed by using visual analog scale (VAS) at 12 hour intervals. Rescue analgesia, in the form of IV paracetamol 1g given in the case of &gt;7 VAS score was also recorded. Results: Total 100 patients were included according to the inclusion criteria of the study. Patients were randomly divided into two groups; Group A (Epidural) and group B (intravenous). Mean age (years) in the study was 42.39+11.21 whereas there were 37 male and 63 female patients who were included in the study. In our study, mean pain score in group A was 3.16+1.23 which was significantly lower than group B (5.42+1.01), p-value &lt; 0.0001. There was a single mortality in the study. 6 patient’s required ventilatory support due to respiratory complications, 5 in group B and 1 in group A. Conclusion: Epidural analgesia is superior to I/V analgesics in pain management of moderately severe pancreatitis and it also reduces respiratory morbidity in these patients.

Effectiveness of Standard post-operative Care on Post-operative Outcome Evaluation among Women Undergone Lower Segment Cesarean Section in Selected Hospital: A Narrative Review

Background: Present study focuses on effectiveness of standard post-operative care on post-operative evaluation among women undergone lower segment cesarean section in selected hospitals. Standard post operative care basically stands for list of non-pharmacological or pharmacological measures, procedures and methods adopted by the investigator/care giver during post-operative period of women undergone lower segment cesarean section for the reduction of negative post-operative outcomes or complications and to fasten recovery. Present study encompasses articles on post-operative care in terms of one, two or more than two or three measures or interventions as post-operative care measures adapted to reduce post-operative complications like use of music therapy, foot-hand massage therapy, planned early ambulation, planned ambulation techniques etc. for post-operative complications and pain relief.&#x0D; Objective: To identify various post-operative measures or care which can be included in standard post-operative care list and its effectiveness on post-operative outcome evaluation among women undergone Lower segment cesarean section in selected hospitals.&#x0D; Methods: Articles were searched in Google scholar, Pub-med, Medline and research gate by using keywords post-operative care of cesarean section, post-operative outcomes of cesarean section and Cesarean mother.&#x0D; Result: Review includes seven articles showing different non-pharmacological or pharmacological measures or techniques to overcome post-operative complications for early recovery and better outcomes. These measures can be included in standard post-operative care list for positive post-operative maternal and fetal outcomes. These measures include early planned ambulation, planned ambulation techniques, music therapy, Foot and hand massage therapy and use of certain analgesia for pain management in post cesarean women if needed, as per the patient’s condition.&#x0D; Conclusion: Conclusion of the review revealed that there are various measures which can be standardized in post-operative outcome evaluation among women undergone lower segment cesarean section.

Microglial ablation does not affect opioid-induced hyperalgesia in rodents.

Opioids are the frontline analgesics in pain management. However, chronic use of opioid analgesics causes paradoxical pain that contributes to the decrease of their efficacy in pain control and the escalation of dose in long-term management of pain. The underling pathogenic mechanism is not well understood. Microglia have been commonly believed to play a critical role in the expression of opioid-induced hyperalgesia in animal models. We performed microglial ablation experiments using either genetic (CD11b-diphtheria toxin receptor transgenic mouse) or pharmacological (colony-stimulating factor-1 receptor inhibitor PLX5622) approaches. Surprisingly, ablating microglia using these specific and effective approaches did not cause detectable impairment in the expression of hyperalgesia induced by morphine. We confirmed this conclusion with a behavioral test of mechanical and thermal hyperalgesia, in male and female mice, and with different species (mouse and rat). These findings raise caution about the widely assumed contribution of microglia to the development of opioid-induced hyperalgesia.

Influence of Scheduled Analgesics Administration on Surgical Patients’ Pain Relief in Teaching Hospitals in Port Harcourt, Nigeria

Pain is a serious problem for surgical patients during the post-operative period. Surgical patients receiving analgesics for pain management after surgery expect to achieve pain relief. However, current evidence revealed that some patients in teaching hospitals in Port Harcourt do not achieve pain relief during the post-operative period. When patients do not achieve pain relief, they could become upset and frustrated with the care they received, leading to complaints and damage to the reputation of the teaching hospitals. Hence, this study determined the influence of scheduled analgesics administration on surgical patients’ pain relief in teaching hospitals in Port Harcourt, Nigeria.The study utilized survey research design to answer the objectives. The population was 3854 comprising 250 surgical nurses, 1802 surgical patients and 1802 medication charts in teaching hospitals in Port Harcourt. Krejcie and Morgan table was used to obtain the sample size of 152 nurses, 317 patients and 317 medication charts. Multistage sampling method was used to select the participants. A validated questionnaire which was partly adapted, and medication charts audit checklist were used for data collection. Cronbach’s alpha coefficients for the constructs ranged from 0.74 to 0.90. A response rate of 87.1% over all was achieved. Data were analyzed using descriptive and inferential statistics.Findings revealed that scheduled analgesics administration had significant positive influence on surgical patients’ pain relief ( R 2 = .075 , β = 0.273, p <0.05, F (1, 144) = 11.626, p < 0.05). Further findings showed that on the basis of the criterion mean of 3.0, surgical patients’ level of pain relief was very high (M = 1.75). The study concludes that scheduled analgesics administration enhances surgical patients’ pain relief in teaching hospitals in Port Harcourt, Nigeria. The study recommends that surgical nurses should follow the analgesics schedule prescribed for patients after surgery to increase and sustain pain relief among surgical patients. Keywords: Pain relief, Scheduled analgesics administration, Surgical patients, Teaching Hospitals DOI: 10.7176/JHMN/88-07 Publication date: April 30 th 2021

GUDA VARTI FOR POST-OPERATIVE PAIN MANAGEMENT- ROAD LESS TRAVELLED

Acute pain is an unpleasant sensory, emotional and mental sensation (experience) associated with vegetative signs, psychological response and changes in behavior. Post-operative pain is one such example and adequate management becomes utmost necessary. In Shalya tantra practice, proctology is the field of excellence for many practitioners and post-operative pain is an acquaintance difficult to handle. Many practitioners still resort to using contemporary I.M OR I.V analgesics for pain management which have proven ADR’S due to lack of availability of Ayurvedic analgesics for management. Vartis (suppositories) was in vogue since pre-historic times and have been mentioned in almost all Ayurvedic texts for various disorders with suitable formulations and various modes of insertion, e.g.: Ratadi varti for Shoola. Ayurveda also has a wide-range of drugs mentioned for relieving pain which have not been used to the full potential. Hence Guda varti as a drug delivery system for pain management needs to be explored in Ayurveda Shalya tantra practice.

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial

Serratus anterior plane block (SAPB) was evaluated that in patients with the complaint of rib fracture pain in terms of total analgesic consumption and pain scores. Sixty patients with rib fracture and NRS (Numeric Rating Scala) pain scores equal or greater than four were included in randomized controlled study. Patients were randomized to perform SAPB or control group. Primary outcome was total tramadol consumption in 24h. Secondary outcomes were NRS scores (after Patient Controlled Analgesia (PCA) application 30min, first, second, 4 th, 6 th, 12 th, 24 th hour), peripheral oxygen saturation (first and 24 th hour after PCA application), chronic pain. and complications. The total tramadol consumption significantly lower in group S (p=0.02). NRS scores after 30min, 1h, 2h, 4h, 6h, 12h, and 24h were significantly lower in group S than in group C (p<0.001, p<0.001, p<0.001, p<0.001, p=0.002, p=0.026). The total number of patients who reported of chronic pain at rest and during effort was significantly lower in group SAPB than in group C (p=0.006). Nine patients in group C were reported of pain, four of whom had pain at rest and five had pain during effort. One patient in group S was reported of pain during effort. This study demonstrated that SAPB, as part of multimodal analgesia in pain management due to rib fractures, is safe and effective in reducing acute pain.

Anaesthesiologist’s perspective of laparoscopic adrenalectomy - A case report with current concepts in management

Pheochromocytoma is a rare tumor of adrenal gland, treatable, curable cause of hypertension and may lead to premature death if not treated early. Medical management by multidisciplinary team is essential for hemodynamic stability during the perioperative period. General anaesthesia with thoracic epidural block offers adequate stress control as hemodynamic fluctuations are quite common and significant during induction, peritoneal insufflation and tumor manipulation. Newer modalities of diagnosis, short acting drugs to control hypertension, vigilant anaesthetic management with beat to beat monitoring of hemodynamics significantly improves patient’s safety. Laparoscopic mobilisation of the adrenal helps in minimal manipulation of the tumour and thus minimising the resultant catecholamine surge. However, hypotension upon ligation of adrenal vein is inevitable. Noradrenaline (NA) remains the vasopressor of choice which has to be continued post operatively. A thorough pre-anaesthetic evaluation, preparation and execution with a multimodal analgesic pain management in a high dependency unit aid in early ambulation and discharge of the patient.

Drug use evaluation of opioid analgesics in pain management among patients with hematopoietic stem cell transplantation

BackgroundHematopoietic stem cell transplantation (HSCT) patients usually experience mucositis, musculoskeletal pain associated with high-dose chemotherapy, radiation, post-HSCT infection, or graft-versus-host disease. Pain management is important for the patients’ quality of life. We evaluated appropriate opioid analgesic use in HSCT patients to propose effective pain management strategies.MethodsA retrospective analysis was conducted using electronic medical records of adult patients with HSCT treated with opioids for moderate to severe pain at Seoul National University Bundang Hospital. The numeric rating scale (NRS) was used in pain management. NRS scores of 4‒10 correspond to moderate to severe pain. Appropriate opioid analgesic use was evaluated following published cancer pain management guidelines.ResultsIn total, 119 cases were evaluated, including 369 episodes of moderate to severe pain. Mucositis-related, musculoskeletal, and headache pain occurred in 62.6%, 25.8%, and 6.0% of episodes, respectively. Frequently used opioids were intravenous tramadol (84.9%), fentanyl patch (73.9%), and intravenous morphine sulfate (68.9%). Intravenous and topical administrations were used for mucosal pain. In total, 95.0% of patients received appropriate short-acting opioids for initial pain management, 80.5% received appropriate doses of short-acting opioids, appropriate opioids dose adjustment was done after first assessment in 95.5% of patients, and 85.6% were converted to appropriate long-acting opioids.ConclusionShort-acting opioid analgesic use for initial pain management and dose adjustment after assessment were appropriate. However, initial and conversion dosages recommended by guidelines may be difficult to implement considering the severity of HSCT patients. Pain management guidelines specific for HSCT patients should be developed in the future.

Authorized Agent-Controlled Analgesia for Pain Management in Critically Ill Adult Patients.

Patient-controlled analgesia is commonly used for adult patients requiring parenteral opioid analgesia in the postoperative setting. However, many patients are unable to use patient-controlled analgesia because of physical or cognitive limitations. Authorized agent-controlled analgesia, in which a nurse or family member activates the patient-controlled analgesia device, has been studied in the pediatric population but has received little attention in adults. To evaluate the efficacy of authorized agent-controlled analgesia in critically ill adult patients. A retrospective pilot study was conducted involving 46 patients who were placed on an authorized agent-controlled analgesia protocol in a mixed medical/surgical adult intensive care unit. Critical-Care Pain Observation Tool scores were abstracted for the 24 hours before and after initiation of authorized agent-controlled analgesia. Authorized agent-controlled analgesia was administered by nurses only. The mean (SD) change in pain score was -3.4 (2.0) (95% CI, -4.0 to -2.7), representing a 69% decrease in the mean (SD) pain score from before to after initiation of authorized agent-controlled analgesia (4.8 [1.8] vs 1.5 [1.6]; P < .001). When the results were controlled for time, sedative administration, and opioid medication administration, the effect of authorized agent-controlled analgesia initiation on pain scores remained significant (P < .001). Use of authorized agent-controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.

Automedicación en estudiantes de último curso de Enfermería, Fisioterapia y Medicina de la Universidad de Córdoba

IntroductionSelf-medication is defined as the consumption of medicines on a person's own initiative in order to alleviate some health problem without medical advice or an appropriate diagnosis. This practice is not only considered a major problem for the consumer, but also for public health when it involves antibiotics. The aim of this work is to determine the prevalence of self-medication in final year Nursing, Physiotherapy, and Medicine students at the University of Cordoba, and other factors associated with it. MethodsA descriptive, cross-sectional study was designed using a validated questionnaire that was completed telematically and anonymously by the students. Chi-squared and Kruskal-Wallis tests were used for the statistical analysis. ResultsA total of 90.8% of the students confirm that they use self-medication, with the most common medicine used among the students being analgesics for pain management. Around half (47.7%) of the self-medicated students only took one drug. Results show that the knowledge acquired during their studies promotes this self-care practice, using their knowledge as the main source of information. The community pharmacy is the main source for medicines. ConclusionSelf-medication is common among final year Nursing, Physiotherapy and Medicine students at the University of Cordoba. The high prevalence of self-medication in these students requires reflection about the importance of Education on potential risks associated with self-medication. It is recommended that an education pathway is establishes in order to make these students aware of the dangerousness of self-medication.

Pain assessment and management: An audit of practice at a tertiary hospital.

BackgroundIn spite of advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in surgical wards. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, the current practice must be understood.AimThe aim of this article was to evaluate pain assessment and management of patients in two surgical wards at a tertiary hospital in South Africa.SettingThe study was conducted within the Western Cape Province of South Africa in a government-funded tertiary academic institution. The patients at this hospital are generally from the low-income strata and live in resource-poor communities.MethodsA cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward of a tertiary hospital in South Africa over a span of 1 month were targeted for review. Medical folders that were not available or had missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan.ResultsA total of 168 folders were available for review. Nearly half of the patients had no documented pain assessment. The Verbal Rating Scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge of the practitioner and were not evidence-based.ConclusionPain assessment and management was a problem in the two wards reviewed, which is similar to the findings from studies referenced in this text. Health professionals must be empowered to manage pain adequately. An assessment tool that integrates the biopsychosocial factors that influence the pain experience should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.