Importance Of Pain Relief Research Articles

Practical use of non-steroidal anti-inflammatory drugs in farm practice

The importance of pain relief in farm animals has never been further up the agenda for modern food production and farm animal practice. This has been driven by increased awareness amongst farmers, veterinary surgeons and consumers. This article looks at the practical use of non-steroidal anti-inflammatory drugs (NSAIDs) in farm animal practice for both adults and youngstock. The basic mode of action of NSAIDs is discussed and some of the evidence base that has been growing over the use of NSAIDs in cattle. It also highlights some of the present requirements of some of the retailers and auditing bodies.

The Effect of Adding Lidocaine to Patient Controlled Analgesia with Morphine on Pain Intensity after Caesarean Section with Spinal Anesthesia: A Double-Blind, Randomized, Clinical Trial.

BACKGROUND:Caesarean section is one of the commonest gynaecological surgeries.AIM:Given the importance of pain relief after caesarean section surgery as well as contradictions in the studies conducted on intravenous lidocaine analgesic effects, this study aimed to evaluate the effect of adding lidocaine to patient-controlled analgesia (PCA) with morphine on pain intensity after caesarean section surgery.MATERIAL AND METHODS:In a double-blinded, randomised clinical trial, 80 women who were scheduled for caesarean section surgery with spinal anaesthesia at Sari Imam Khomeini Hospital in 2017 were randomly assigned into two intervention and control groups. After surgery, all patients were connected to a morphine PCA pump. The PCA solution (total volume = 100 ml) in intervention group contained 50 ml of 2% lidocaine and 30 mg (3 ml) of morphine in 47 ml normal saline. In the control group, the PCA pump contained 30 mg (3 ml) of morphine, and the rest (97 cc) was normal saline. Patients’ pain intensity was assessed at 2, 4, 6, 12, 18 and 24 hours after surgery using a visual analogue scale (VAS). Additionally, their postoperative nausea and vomiting, duration of hospitalisation, duration of ileus relapse after surgery, and patients’ satisfaction after surgery were evaluated. Data were analysed using SPSS version 22 software.RESULTS:The mean and standard deviation of pain intensity in all patients at the intervals of 2, 4, 6, 12, 18 and 24 hours after surgery were 5.91 ± 1.57, 4.97 ± 1.55, 3.84 ± 1.60, 3.54 ± 1.45, 2.56 ± 1.70 and 0.94 ± 1.70, respectively. Data analysis revealed that, regardless of the groups, postoperative pain intensity significantly decreased (P < 0.0001). However, there were no significant differences between the two groups in terms of mean postoperative pain intensity at any time interval (p > 0.05). Also, there was no significant difference between the two groups in terms of frequency of receiving the diclofenac suppositories after the surgery (p > 0.05). Additionally, there was no statistically significant difference between the two groups in terms of postoperative nausea and vomiting, duration of hospitalisation, duration of postoperative ileus relapse and patients’ satisfaction (p > 0.05).CONCLUSION:Based on the results of this study, it seems that adding lidocaine to PCA with morphine, compared with morphine PCA alone, do not have a significant effect on reducing the pain intensity after cesarean section using spinal anaesthesia. Although, further studies with larger sample size are warranted.

Partial avulsion of the ulnaris lateralis and enthesiopathy of the lateral epicondyle of the humerus in a thoroughbred race horse

BackgroundThere is relatively little literature on elbow disease in the horse. The only published reports on soft tissue conditions describe collateral ligament and biceps brachii injuries.Case presentationA three-year old Thoroughbred gelding presented with a history of acute onset right forelimb lameness of less than one week duration, one month after commencing training in a National Hunt racing yard. Physical examination and peri-neural anaesthesia failed to localise the lesion. Lameness was localised to the distal humerus by nuclear scintigraphy and intra-articular anaesthesia. A partial avulsion of the tendinous origin of the ulnaris lateralis and enthesiopathy of the lateral humeral epicondyle was diagnosed on ultrasonography. Ultrasonographic findings were loss of longitudinal fibre pattern, a discrete hypo-echoic region within the ulnaris lateralis tendon of origin, and remodelling of the lateral epicondyle of the right humerus at the site of the origin of the ulnaris lateralis. No abnormalities were identified on radiography. The lameness did not resolve with rest, but was successfully treated with extra corporal shockwave therapy (ECSWT) and intra-lesional corticosteroid injections.ConclusionThis is the first report of partial avulsion of the ulnaris lateralis and enthesiopathy of the lateral humeral epicondyle in the horse. In contrast to other reported soft tissue conditions of the elbow, this horse had a successful return to work. This case highlights the value of ultrasonography in assessing peri-articular soft tissues, and the importance of pain relief as treatment in some soft tissue injuries.

Pre-hospital coronary heart disease: Analysing performance indicators

The prevalence of coronary heart disease is massive within the UK and is the leading cause of myocardial infarction. Between a third and two thirds of associated deaths occur in the pre hospital setting, many within the first few minutes of symptom onset. Immediate quality treatment is proven to improve patient survival however recent evidence suggests patients are not receiving all the elements of a quality care bundle. Pain management has been identified as one area which requires national improvement to meet standards directed by the National Service Framework for Coronary Heart Disease. In response, Ambulance services nationally have used clinical performance indicators to address quality issues in order to enhance practice and achieve target. This article reviews the importance of pain relief in the treatment of acute coronary syndrome and analyses the use of clinical performance indicators in the pursuit of best practice within the North West.

The double cross of morphine: Stopping OIH in its tracks.

The likelihood of suffering most chronic pain conditions increases with age. Thus, as the elderly population of the world expands, and as the incidence of pain goes up with age, it is necessary to place an increased emphasis on the importance of pain relief as a vital standard of care. Opioid medications remain not only the gold standard analgesic against which all others are compared, but also the primary source of analgesia for chronic cancer and non-cancer pain. In line with this, the licit global consumption of morphine increased by a factor of 7 between 1989 and 2009 (International Narcotics Control Board, INCB).

Semi-qualitative study of staff attitudes to care following decision to withdraw active treatment in a neonatal intensive care unit

The management of an infant after a decision to withdraw active treatment creates dilemmas. Both lingering death and active killing are undesirable, but palliative interventions can hasten death. We investigated what staff on our neonatal unit thought were the limits of acceptable practice and why. We administered a structured interview to elucidate their views, and asked them to justify their answers. The interviews were analysed quantitatively and qualitatively. A total of 25 participants (15 nurses and 10 doctors) were recruited. 80% emphasized the importance of pain relief following withdrawal, 60% mentioned meeting parental needs at that time. 76% agreed that death can be a desired consequence of withdrawal, yet 52% felt that death should never be hastened. 96% felt that morphine is acceptable after withdrawal, and 72% would give a higher than normal dose if necessary. 56% would stop paralysis at extubation but not reverse it, while 24% would continue paralysis. 16% would consider a drug that ended life instantly in some cases. A wide variety of views emerged, but there were two main positions, a cautious majority, and a more proactive minority. Apparent contradictions within the majority position could be explained using the doctrine of double effect and the acts and omissions distinction.

Treatment of Pain and Stress in the Neonate

After completing this article, readers should be able to: 1. Describe the pain assessment tools used for preterm and term neonates. 2. List painful procedures in the neonatal intensive care unit (NICU). 3. Describe nonpharmacologic interventions for alleviating neonatal pain. 4. Describe pharmacologic methods used for neonatal analgesia. 5. Delineate the adverse effects of the common forms of pain relief. Neonates are sensitive to pain and vulnerable to both its short- and long-term effects. However, there is a lack of consistency in both attitudes and practices among NICU staff with regard to pain assessment and management in neonates. Recognition of the clinical importance of neonatal pain and stress has been delayed and hampered by the lack of awareness that newborns are capable of experiencing pain, insufficient knowledge about the developing nervous system, difficulty in assessing neonatal pain, lack of evidence for the safety and efficacy of different modalities available for the treatment of pain, and fears about adverse effects associated with analgesic use. Neonatal pain has been of minimal concern until the last 25 years. For example, at one time, neonates were given paralytic drugs without anesthesia for major surgical procedures because physicians believed that neonates were incapable of interpreting or remembering pain. Further, there was no understanding of the consequences of untreated pain. Newer technologies to sustain life have exposed neonates to multiple invasive procedures and prolonged hospital stays that are associated with acute and chronic pain and stress. In 2001, an international evidence-based group for neonatal pain developed guidelines for the assessment, prevention, and treatment of neonatal pain in an effort to standardize practices for physicians and health care facilities. Within the consensus statement, the group defined general principles to prevent and treat pain and listed the most commonly performed diagnostic, therapeutic, and surgical procedures in the NICU. The guidelines also indicated the …

Canadian Pain Society Position Statement on Pain Relief

The present report outlines key requirements that are central to helping patients manage pain effectively. Although current standards are available as guides for practice, the prevalence of pain suggests that many health professionals do not know and/or cannot relate to these standards. Therefore, a brief, pragmatic statement may be more useful initially for health professionals and patients learning about problematic pain outcomes. The principles in the brief statement produced by the Canadian Pain Society clarify and emphasize key underlying assumptions that have directed the development of many pain standards. The aim of the present paper is to increase awareness of ineffective pain practices and the importance of pain relief, and to stimulate further work in this area.

Knowledge and Attitudes of Health-Care Providers Toward Cancer Pain Management: A Comparison of Physicians, Nurses, and Pharmacists in the State of New Hampshire

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management. Approximately 90% of providers in all three groups were not concerned about addiction among cancer patients. Yet, there was a small percentage of providers who responded in less than optimal ways to items dealing with opioid pharmacology, pain assessment, and the importance of pain relief. Comparison of responses among provider groups indicated that nurses were the most knowledgeable and pharmacists the least knowledgeable about pain assessment. Physicians were the most knowledgeable regarding opioid pharmacology but seemed the least committed to providing optimal pain relief. Further analysis identified a small group of physicians that included a disproportionately high percentage of family practitioners and surgeons who consistently responded in less than optimal ways to items dealing with the importance of pain relief. The results of this study indicate a continuing need for broad-based educational programs in cancer pain management and for new initiatives focused on practitioners who see relatively few cancer patients and may have difficulty accessing traditional educational programs.