Pharmacological Pain Relief Research Articles

The frequency of pharmacological pain relief in university neonatal intensive care units

To evaluate the use of drugs to relieve procedural pain of newborn infants hospitalized in Neonatal Intensive Care Units (NICU) of university hospitals. A prospective cohort study of all newborn infants hospitalized in four NICU during October 2001. The following data were collected: demographic data of patients; clinical morbidity; number of potentially painful procedures and frequency of analgesic administration. Multiple linear regression analysis was performed to study the factors associated with the use of analgesia in this cohort of patients with SPSS 8.0. Ninety-one newborn infants were admitted to the NICU during the study period (1,025 patient-days). Only 25% of the 1,025 patient-days received any systemic analgesia. No specific drug was administered to relieve acute pain during any of the following painful procedures: arterial, venous, capillary and lumbar punctures and tracheal intubation. For chest tube insertion, 100% of newborn infants received specific analgesia. For the insertion of central catheters, 8% of the newborn infants received analgesia. Only nine of the 17 newborn infants that underwent surgical procedures received any dose of analgesics during the postoperative period. Regarding patients who received analgesia, the drug of choice was fentanyl in 93%. The presence of mechanical ventilation increased 6.9 times the chance of the newborn receiving analgesia and the presence of a chest tube increased this chance by 5.0 times. It is necessary to train health professionals in order to shorten the lag between scientific knowledge regarding newborn pain and clinical practice.

Childbirth Experiences in Australia of Women Born in Turkey, Vietnam, and Australia

Migrant women constitute a growing proportion of the childbearing population in many high-income countries. The aim of this study was to investigate experiences of childbirth, including recollection of pain and use of pain relief, in women born in Vietnam, Turkey, and Australia who gave birth in Victoria, Australia. One hundred Vietnamese-born and 100 Turkish-born women were compared with 100 Australian-born women who gave birth in the same metropolitan hospital during the same time period. Only women who had a normal vaginal birth and gave birth to a healthy baby were included. They were interviewed between 24 hours after the birth and hospital discharge. Vietnamese women used less pain relief, reported more pain, and described childbirth overall more negatively than Australian women, while also reporting less anxiety, more confidence, and less panic during labor. Turkish women's responses were more similar to those of Australian women, but they were slightly more satisfied with childbirth overall despite recollecting more pain, and were also more likely to perceive time normally. Turkish women used a similar amount of pharmacological pain relief as Australian women, but used more relaxation and breathing techniques. This study showed that women's responses to childbirth are associated with cultural background. Midwives and other caregivers should be particularly sensitive in assessing Vietnamese women's pain during labor.

Simpson, Semmelweis, and Transformational Change

The first anesthetic for childbirth and the first recognition of the importance of hand hygiene in obstetrics coincidentally occurred within 5 months of one another in 1847. More than 150 years later, one would have thought that these milestone events would have been fully integrated into practice. However, individuals resist transformational change, which is defined as a fundamental alteration in their beliefs, attitude, and behavior, even when they are confronted with incontrovertible facts. This resistance to change may explain why, in 2005, a large percentage of health care providers still do not practice acceptable hand hygiene, and the pain of childbirth continues to be extolled by some as a necessary part of womanhood, just as pharmacologic pain relief is discouraged.

The future role of the anaesthesiologist in pain management

Relieving pain during and after surgery and trauma has always been a basic duty of anaesthesiologists. With their skills and expertise in regional analgesia and pharmacological analgesia, anaesthesiologists have improved management of severe cancer pain. Will there be a place for anaesthesiologists in multidisciplinary pain clinics managing chronic non-cancer pain patients in the future? This is a personal review of the development of pain management as a growing part of the responsibilities of anaesthesiologists during the past three decades and the importance of continued involvement of anaesthesiologists in this interesting and challenging aspect of clinical medicine. Optimal management of pain during and after surgery is a prerequisite for successful short- and long-term rehabilitation after surgery. After surgery, reducing dynamic pain with prolonged optimal epidural analgesia and regional blocks facilitates mobilization and reduces chronic pain. The expertise of well-trained anaesthesiologists in skillfully using regional analgesia and pharmacological pain relief continues to be in demand in palliative care. Some interventional techniques are useful in relieving chronic non-cancer pain in selected patients. Well-trained anaesthesiologist-pain clinicians can perform interventional treatments safely. No doubt, anaesthesiologists will continue to have important roles in pain management in the future.

Does a pregnant woman's intended place of birth influence her attitudes toward and occurrence of obstetric interventions?

A home confinement with midwifery care is still an integral part of Dutch maternity care. It has been argued that the existence of home birth itself influences the course of the birth process positively, which is why obstetric interventions are low in comparison with neighboring countries. This study examined the impact of women's intended place of birth (home or hospital) and the course of pregnancy and labor when attended by midwives. This is a prospective study of 625 low-risk pregnant women, gestation 20 to 24 weeks, enrolled in 25 independently working midwifery practices. The course of labor was measured by the frequency of interventions by midwives and obstetricians. A more non-technological approach to childbirth was observed within the women opting for a home birth compared with the women opting for a hospital birth. Data showed a relationship between interventions and planned birth site: sweeping membranes and amniotomy by midwives were more likely to be conducted in women opting for a home birth. Multiparas opting for hospital birth were more likely to experience consultations and referrals. Within the group of multiparas referred for obstetrician care, women intending to have a home birth experienced fewer interventions (e.g., induction, augmentation, pharmacologic pain relief, assisted delivery, cesarean section) compared with those who had opted for a hospital birth. A large proportion of women desire a home birth. The impact of that choice demonstrated a smoother course of the birth process, compared with women who desired to deliver in the hospital, as measured by fewer obstetric interventions. We suggest that psychological factors (expectation and perceptions) influence both a woman's decision of birthplace and the actual birth process.

Selected coping strategies in labor: an investigation of women's experiences.

Antenatal education classes offer women information about labor and birth and ways of coping with pain and emotional distress. The purpose of this paper was to describe women's experiences of using, starting, and discontinuing three coping strategies in labor that were taught in antenatal education classes. An exploratory research design was used in which 121 women were interviewed within 72 hours of the birth of their first child. Information was obtained on why women initiated and discontinued their use of three coping strategies (breathing technique, postural changes, relaxation technique) and the reported effects of use. The effects of the coping strategies investigated varied widely among participants. Common aspects of care, changes of environment, and use of pharmacological pain relief affected women's discontinuation of coping strategies. The implications of study findings for clinical practice include the need for caregivers to provide women with accurate information about the effects of coping strategies and to be alert to aspects of care that may disrupt women's use of strategies.

Outcomes after pethidine or diamorphine administration

Despite the common use of pethidine (PTD) and diamorphine (DMP) in providing pain control during labour, there is little evidence of their effectiveness. In addition, some studies have suggested that PTD is associated with a poor neonatal and maternal outcome. Conversely, DMP has not been reported to have any major adverse neonatal or maternal outcomes. The objective was to compare the effects of intramuscular PTD with DMP on neonatal outcome, maternal vomiting and further administration of pharmacological pain relief during labour. The study involved retrospective case note analysis of 268 women in their first pregnancy giving birth between February 1999 and May 2000: 134 receiving PTD and 134 receiving DMP as the first pharmacological pain relief in labour for a singleton vaginal delivery following an uncomplicated spontaneous labour at term. The following information was collected: neonatal Apgar score at 1 minute; neonatal resuscitation; time to first infant feed; actual and intended method of feeding; maternal vomiting; and further administration of analgesia. There were no significant differences in the two groups in respect of Apgar score of less than 7, neonatal resuscitation and time to initiate first feed. However, those women receiving PTD were significantly less likely to vomit or to require further analgesia than those receiving DMP.

Swedish women's interest in home birth and in-hospital birth center care.

In Sweden, few alternatives to a hospital birth are available, and little is known about consumer interest in alternative birth care. The aim of this study was to determine women's interest in home birth and in-hospital birth center care in Sweden, and to describe the characteristics of these women. All Swedish-speaking women booked for antenatal care during 3 weeks during 1 year were invited to participate in the study. Three questionnaires, completed after the first booking visit in early pregnancy, at 2 months, and 1 year after the birth, asked about the women's interest in two alternative birth options and a wide range of possible explanatory variables. Consent to participate in the study was given by 3283 women (71% of all women eligible). The rates of response to the three questionnaires were 94, 88, and 88 percent, respectively. One percent of participants consistently expressed an interest in home birth on all three occasions, and 8 percent expressed an interest in birth center care. A regression analysis showed five factors that were associated with an interest in home birth: a wish to have the baby's siblings (OR 20.2; 95% CI 6.2-66.5) and a female friend (OR 15.2; 95% CI 6.2-37.4) present at the birth, not wanting pharmacological pain relief during labor and birth (OR 4.7; 95% CI 1.4-15.3), low level of education (OR 4.5; 95% CI 1.8-11.4), and dissatisfaction with medical aspects of intrapartum care (OR 3.6; 95% CI 1.4-9.2). An interest in birth center care was associated with experience of being in control during labor and birth (OR 8.3; 95% CI 3.2-21.6), not wanting pharmacological pain relief (OR 2.3; 95% CI 1.3-4.1), and a preference to have a known midwife at the birth (OR 2.2; 95% CI 1.6-2.9). If Swedish women were offered free choice of place of birth, the home birth rate would be 10 times higher, and the 20 largest hospitals would need to have a birth center. Women interested in alternative models of care view childbirth as a social and natural event, and their needs should be considered.

More than a sore mouth: patients' experience of oral mucositis.

To explore patients' experience of chemotherapy-induced oral mucositis. Interpretive descriptive, phenomenologic. The cancer center of a metropolitan teaching hospital in South Australia. A purposive sample of six participants undergoing intensive cytotoxic therapy associated with autologous hematopoietic stem cell transplantation. Patients were interviewed at different stages of their treatment trajectory and asked to relate their experience of oral mucositis as it developed and resolved. Participants' reports indicated three distinct phases representing linear time in the course of their mucositis: the preparatory phase, the peak phase, and the persisting phase. Five themes further abstracted were the presence of nurses, therapeutic interventions, manifestations of mucositis, the distress of eating (and not eating), and whether the treatment was worthwhile. Oral mucositis is much more than a sore mouth. The effects of mucositis are widespread and can have a marked effect on patients' psychological well-being. Care centers often focus on pain control through pharmacologic intervention and overlook the effects of other sequelae. Nurses' role in helping patients to cope with mucositis should encompass more than providing pharmacologic pain relief.

Warm water bathing did not reduce use of pharmacological analgesia during the first stage of labour

(2001) Birth 28, 84. Eckert K, Turnbull D, MacLennan A. . Immersion in water in the first stage of labor: a randomized controlled trial. . Jun; . : . –93...

An investigation into the use of aromatherapy in intrapartum midwifery practice.

The principal aim of the study was to examine the contribution of aromatherapy to the promotion of maternal comfort during labor and as a tool to improve the quality of midwifery care. Evaluative study. Delivery suite in a large British teaching hospital with approximately 6,500 deliveries per annum. A total of 8,058 mothers were evaluated between 1990 and 1998. Women were offered aromatherapy to relieve anxiety, pain, nausea and/or vomiting or to strengthen contractions. Routine data collected on the use of aromatherapy over the period were analyzed. Data from the unit audit were used to provide a comparison group of mothers not given aromatherapy (n = 15,799) from the study center. Outcome measures include mothers' ratings of effectiveness, outcomes of labor, use of pharmacologic pain relief, uptake of intravenous oxytocin, reported associated symptoms, and annual costs. The use of aromatherapy during childbirth was an increasingly popular care option with mothers and midwives. More than 50% of mothers rated it as helpful, and only 14% found it unhelpful. The use of aromatherapy was not confined to low-risk mothers. Sixty percent of the sample were primigravidae, and 32% overall had had their labor induced. The administration of aromatherapy in childbirth did appear to reduce the need for additional pain relief in a proportion of mothers. More than 8% of primigravidae and 18% of multigravidae used no conventional pain relief during labor after using essential oils. During the years of the study, the use of pethidine in the study center declined from 6% to 0.2% of women. The study also showed that aromatherapy may have the potential to augment labor contractions for women in dysfunctional labour. A very low number of associated adverse symptoms were reported (1%). This study represents a successful example of the integration of a complementary therapy into mainstream midwifery practice and forms a basis for future research.

Experience of labor and birth in 1111 women

The association between women's overall experience of labor and birth and a range of possible explanatory variables were studied in a group of 1111 women who participated in a birth center trial. Data were collected by a questionnaire in early pregnancy (demographic background, parity, personality traits, and expectations), hospital records (pharmacological pain relief, induction, augmentation of labor, duration of labor, operative delivery, and infant outcome), and a follow-up questionnaire 2 months after the birth (the principal outcome “overall experience of labor and birth,” pain, anxiety, freedom in expression, involvement, midwife, and partner support). Logistic regression was conducted by including all variables that were associated with the birth experience when analyzed one by one. In a second regression analysis, only explanatory variables measured independently of the principal outcome were included; that is, only data collected from the pregnancy questionnaire and the hospital records. The first regression analysis identified five explanatory variables: involvement in the birth process (perceived control) and midwife support were associated with a positive experience; anxiety, pain, and having a first baby with a negative experience. Parity remained a significant predictor in the second regression analysis, but the others were replaced by augmentation of labor, cesarean section, instrumental vaginal delivery, and nitrous oxide (Entonox), which were all associated with a negative birth experience.

TRAUMATIC NEURALGIAS: Complex Regional Pain Syndromes (Reflex Sympathetic Dystrophy and Causalgia): Clinical Characteristics, Pathophysiologic Mechanisms and Therapy

Complex regional pain syndromes (CPRS) may develop as a disproportionate consequence of a trauma affecting the limbs without (CRPS I, reflex sympathetic dystrophy) or with (CRPS II, causalgia) obvious nerve lesions. The clinical picture of CRPS consists of asymmetrical distal extremity pain, swelling, and autonomic (sympathetic) and motor symptoms. Changes in the peripheral and central somatosensory, autonomic and motor processing, and a pathologic interaction of sympathetic and afferent systems are discussed as underlying pathophysiologic mechanisms. Therapeutic strategies include pharmacologic pain relief, sympatholytic interventions, and rehabilitation.

The complexity of labor pain: experiences of 278 women.

All women giving birth over a period of 2 weeks in a major city of Sweden, except non-Swedish speaking women and those with elective Caesarean sections, were asked about their experience of pain 2 days after the birth. The sensory (pain intensity) and effective (negative or positive experience) dimensions of pain, as well as need for pain relief during labor were explored. The 278 women who returned completed questionnaires (91%) reported high levels of pain, 41% worst imaginable pain, in spite of wide use of pharmacological pain relief. Only 9% had no analgesia. Pain was not an entirely negative experience, 28% assessing it as more positive than negative, suggesting that coping with pain is a rewarding experience for some women. More than 30 different explanatory variables were included in regression analysis to explain the variation in pain intensity and pain attitude scores, but only five contributed to the respective model. Most of the variables explaining pain intensity, namely anxiety during labor, expected pain, expected birth experience, midwife support and duration of labor, differed from the variables explaining attitude to pain. These were pain intensity, anxiety, expected birth experience physical well-being during pregnancy and emergency Caesarean section. The explanatory values were relatively low, especially for the model explaining pain intensity (R2 = 15%). The findings are discussed in the light of the different character and meaning of childbirth pain compared with pain related to disease.

Importance et Réalisation des Attentes de Primiparres Relativement à L'Expérience de la Naissance

The discrepancy between childbirth as planned and childbirth as actually experienced raises concerns about the consideration accorded to women's demands. This descriptive study examines the importance and fulfillment of primiparas' child-birth expectations. The sample was formed of 125 pregnant women recruited from groups attending prenatal classes in community health care centres. Participants completed structured prenatal and postnatal questionnaires about six variables related to childbirth experience: control, partner's support, nurse's support, pharmacological pain relief, obstetrical interventions, and first contact with the baby. Childbirth expectations are numerous and their importance varies from one woman to another. Also, their fulfillment varies depending on their nature and is rarely associated with the importance given to them by the woman. Overall, three variables, control, partner's support, and nurse's support were ranked equally as the most important by participants. Nurses should make more efforts to fulfill women's expectations and individualize their approach. They are instrumental in having this short but intensely meaningful event in a woman's life contribute to the development of a healthy identity as a mother.

Pain and pain relief in labour: parturients' experiences

The experiences of 890 parturients were studied across Finland during one week to determine how they experienced labour pain and how effective they regarded the means to alleviate it. The majority of women (72%) had been afraid of labour and 88% had intended to request some pharmacological pain relief. 84% of primiparous and 72% of multiparous rated their pain severe or unbearable. Epidural analgesia was found to be the most effective method in the first stage of labour, but in the second this superiority was no longer apparent. Unfortunately, it seems to be readily available only during office hours in spite of the fact that the majority of deliveries happen outside of that time.

Nursing Actions to Prevent and Alleviate Pain in Hospitalized Children

Nurses are confronted daily with the responsibility to care for hospitalized children in pain, yet the substantive knowledge base about that care and how effective it is remains extremely limited. Although there is initial evidence of effectiveness of several pharmacologic and nonpharmacologic pain relief approaches, little evidence of use or effectiveness in clinical nursing practice exists. To begin to address this knowledge deficit, two studies conceptualized within Orem's (1991) general theory of nursing were undertaken: one involving ethnographic interviews to determine what pain relief actions are taken by nurses with recognized expertise in caring for children in pain and another, follow-up survey to examine the frequency with which these actions are used by general nursing staff. Data about perceived effectiveness of the actions were also obtained. The results of these two studies of nursing actions to prevent and alleviate pain in hospitalized children document that nurses use a wide variety of creative methods to relieve pain. From interviews with the nurse experts both specific actions and action patterns and themes were identified. Furthermore, these patterns were congruent with methods of helping used by nurses as described by Orem. Results of this research currently serve as the basis for development and testing of nursing action protocols for alleviation of pain in hospitalized children.

Treatment Options for the Relief of Pain During Childbirth

Despite its severity, the disposition of women towards pain during childbirth is influenced by many complex personal and cultural factors. Such influences may inspire a degree of stoicism towards labour pain which would be extraordinary in other painful circumstances. Nevertheless, the majority of women who deliver in a modern obstetric unit request some form of pharmacological pain relief. An important component of proper antenatal education, therefore, is to provide impartial information about the various analgesic alternatives which are available within each centre. Regimens of analgesia which depend on the systemic absorption of drugs (e.g., parenterally administered opioids; inhalational analgesia) are simple to administer but they have limited efficacy and are commonly associated with unpleasant central side effects. While some innovations in actual drug administration have been introduced, it is unlikely that any further major improvements will be feasible using the systemic approach to analgesia. Epidural analgesia has become established as the most effective and consistently reliable method of providing pain relief in labour. Recent advances have demonstrated that many of the adverse effects traditionally associated with epidural analgesia can be substantially reduced by administering local anaesthetics in smaller doses. It is becoming apparent that additional patient benefits are possible when epidural opioids are also used in combination with local anaesthetics. Techniques which allow the mother to exercise personal control over her epidural analgesia requirements are received more favourably and may help reduce the need for obstetric intervention.

Variations Between Midwives Regarding Administration of Obstetrical Analgesia

Variations among 32 midwives involved in a total of 1578 deliveries were studied regarding attitudes to and use of obstetrical analgesia. Relevant data were obtained from the register of the maternity department of a Swedish regional hospital. This was complemented with information about the midwives' attitudes to pharmacological pain relief in labour and delivery, collected by means of a mailed questionnaire. Variations between midwives (range), expressed as percentages of each midwife's total number of deliveries, were considerable: epidural block (EDA), 9-48%; Pethidine, 0-41%; Entonox (N2O/O2), 8-62%; pudendal block (PDB), 11-71%. Midwives working on night-shift used less EDA, but more pethidine, than their day-shift colleagues. 59% of all the midwives were critical of current levels of obstetrical use of analgesics in Sweden, while 41% felt the level to be about right. Night-shift midwives were rather more critical than day-shift midwives. Midwives critical of current levels of obstetric medication used EDA and PDB less often than their more enthusiastic colleagues, but the difference was not statistically significant. On the other hand, critical midwives used more Pethidine (p less than 0.05) and also more Entonox than their less critical colleagues, though again the difference was statistically non-significant.