Received Pain Relief Research Articles

Patients' narratives concerning good and bad caring.

Narratives from patients (n = 80) and patients' relatives (n = 12) were collected to illuminate experiences of good and bad caring episodes and to obtain descriptions of good caring. Narratives describing good caring included such task aspects as swift and correct assessment and access to information. Aspects less frequently mentioned were, for example, being given time, receiving pain relief and good food. Relationship aspects mentioned; having an interest shown in the care, being taken seriously and being cared about. There are parallels regarding relationship aspects between the narratives concerning good and bad caring episodes; for example what was praised in the good caring narratives was criticized in those describing bad caring. Such parallels were being/not being trusted, being/not being believed and being/not being respected. The narrations concerning bad caring were more specific and more vivid than those about good caring. The authors' interpretation was that the bad episodes were unexpected and very painful and therefore remained imprinted in the patients' memories. The descriptions of good caring included relationship aspects in only 34 cases, task aspects in only five cases and a combination of both in 50 cases. The ultimate purpose of the study was to obtain a basis for the development of a policy for good caring founded on patients' experiences. It is desirable that further studies be undertaken within various clinical specialties which would also take into consideration medical, social and cultural perspectives.

Effectiveness of transnasal butorphanol for the treatment of musculoskeletal pain

A prospective, open-label study of the effectiveness of transnasal butorphanol in the treatment of pain resulting from musculoskeletal injuries. Twenty-eight patients with strains (n = 20), fractures (n = 6), contusions (n = 1), and stab wounds (n = 1) were included. All patients were examined by an attending level emergency medicine physician and deemed to have pain severe enough to warrant parenteral narcotic analgesia. All patients received an initial 1-mg dose of transnasal butorphanol. Subsequent dosing was flexible depending on response to the initial dose. All patients received pain relief from transnasal butorphanol, and only one requested alternative analgesic medication. Fifty-seven percent (n = 16) of patients noticed at least a little relief of pain within 5 minutes of administration and 93% (n = 26) received at least a little relief within 15 minutes. Seventy-one percent of the patients received a 50% reduction of pain within 60 minutes. No serious side effects were noted, but drowsiness occurred in 82% (n = 23) and dizziness in 54% (n = 15) of the patients. One patient discontinued participation in the study because of nausea. In this limited trial transnasal butorphanol proved to be a rapidly effective opioid analgesic. Further controlled studies comparing transnasal butorphanol with standard parenteral narcotics are needed.

Postoperative pain relief, from the patients5 and the nurses' point of view

In this prospective, consecutive study, 191 patients were interviewed before and after surgery (orthopaedic, gynaecological, abdominal and urological operations) about their attitude to and the quality of received pain relief, respectively. In addition, nurses working in the surgical units involved in the study were asked to answer a questionnaire covering attitudes to postoperative pain and pain treatment. Of the patients, 47% were in pain at the time of the postsurgical interview, 10% had not any analgesic prescribed at all and 15% had received less than prescribed. In 36% of the cases there was a discrepancy between the amount of analgesic prescribed by the surgeon and the amount prescribed by the anaesthetist. In 80% of the patients the pain outlasted the first postoperative day, but only 64% would always tell the staff if they had pain. Seventeen per cent of the patients had never been asked about their postoperative pain status. Preoperative pain had a significant correlation to postoperative pain. Although the results are not impressive, they do constitute some improvement compared to previously published studies. Fifty-one nurses (71% of the total nursing staff) answered the questionnaire. Of these, 63% were sometimes in doubt about the physicians' prescriptions, 55% would occasionally refuse to give analgesics for various reasons, and 37% were not satisfied with the routines of pain control in their ward. Knowledge of pain treatment and communication between surgeons, anaesthesiologists, nurses and patients must be improved to make postsurgical pain relief adequate.

One-year results of semiconductor transscleral cyclophotocoagulation in patients with glaucoma.

We evaluated 30 consecutive patients with glaucoma treated with semi-conductor diode transscleral cyclophotocoagulation to determine the results and complications of this procedure. Twelve months after surgery the mean (+/- SD) preoperative intraocular pressure of 32.5 +/- 10.9 mm Hg (n = 30) had dropped to 20.8 +/- 15.6 mm Hg (n = 19) (P = .018, paired Student's t test), while the mean number of preoperative medications received decreased from 2.0 to 1.8 (P = .060, Wilcoxon's Signed Rank Test). One year after surgery three patients (10%) were unavailable for follow-up, eight (27%) had required other surgical procedures to control the intraocular pressure, 17 (56%) had controllable intraocular pressure of 21 mm Hg or below or received pain relief from the diode laser alone, and two (7%) patients with controlled intraocular pressure had suffered visual loss. Other complications included mild conjunctival hyperemia and uveitis in all patients and mild ocular pain in six patients. This study suggests the usefulness of diode transscleral cyclophotocoagulation in reducing the intraocular pressure for up to 1 year.

Intrathecal morphine for intractable pain secondary to cancer of pelvic organs

Sixty-two patients with intractable pain secondary to cancer of the pelvic organs were managed with intrathecal injections of morphine. Forty-six patients experienced pain relief from an initial test dose that ranged from 0.5 to 2.0 mg. In order to provide long-term pain relief, these 46 patients were further treated with repeated single injections (14 patients), external catheter (28 patients), or implanted pump (4 patients). Twenty-four of the 46 patients received pain relief without developing tolerance or side effects or experiencing mechanical failure of the application systems. When side effects developed, they were generally itching, sphincter disorder and somnolence. No serious respiratory depression was noted. Intrathecal morphine offers a hopeful alternative to systemic narcotics or ablative neurosurgical procedures in the management of terminal cancer pain.

Clinical correlates of women requesting labour epidural analgesia in a tertiary hospital in Nigeria

To evaluate the clinical correlates of women who received pain relief in labour with lumbar epidural analgesia and also investigate the labour outcome. A hospital -based case-control study conducted in a tertiary care facility in Nigeria. The clinical characteristics and delivery outcome of women who had epidural analgesia in labour were compared to those without. The utilisation rate of labour epidural analgesia during the study period was 13/1000 women. Tertiary education was significantly higher among women who had epidural analgesia in labour (22.7% vs 3.4%, p=0.0009). There were no statistically significant differences between women who had labour epidural analgesia and the controls in terms of labour and delivery by caesarean section. The second stage of labour was prolonged in women who received epidural for pain relief in labour (p=0.005). The neonatal indices (Mean birth weight or Apgar score<7 in first minute) were similar. This study suggests that labour epidural analgesia is not associated with increased caesarean section and adverse foetal outcome. This is of value in increasing the acceptance of this service by pregnant women in Nigeria.