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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Investigated postoperative PRN analgesic medication decisions regarding children in 113 hospital nurses, using analog stimuli. Nurses with greater narcotics knowledge and comfort indicated they would provide significantly more medication. Nurses provided more analgesics to children showing higher pain, and on the first than on the third postoperative day. Seriousness of child's condition also affected medication decisions. On the first day, nurses gave less medication to the child with than without permanent sequelae, whereas on the third postoperative day nurses provided more analgesics to the child with than without sequelae. These findings were consistent across high and low pain conditions. Nurses' ratings of children's pain were also affected by seriousness and time since surgery. Findings are discussed with reference to problems of undermanagement of children's pain.
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PMID:Factors affecting nurses' decisions to administer PRN analgesic medication to children after surgery: an analog investigation. 167 12

In a prospective open study we tested the Edmonton injector (EI), a device designed by our group for subcutaneous injection of narcotics. In 25 patients, the EI was used for patient-controlled analgesia (PCA); mean duration of treatment was 28 +/- 10 days. Mean equivalent daily dose of morphine was 160 +/- 85 mg. All patients found the EI safe and simple to operate. The main reason for discontinuation was death (10 cases) or return to oral narcotics (8 cases). In 20 patients who were admitted to the hospital and were too ill to learn PCA, the EI was used for regular s.c. administration by nurses. Narcotics were administered every 4 h and extra doses were administered on a 'PRN' basis. Waiting time for a 'PRN' dose in 8 patients before starting the EI was 18 +/- 7 min; after the EI was started, it was 3 +/- 4 min (P less than 0.01). We conclude that the EI is safe, effective and inexpensive, and that it will be particularly useful in smaller hospitals and developing countries.
Pain 1991 Feb
PMID:The Edmonton injector: a simple device for patient-controlled subcutaneous analgesia. 205 83

The present study examined the impact of two methods of pain management on recovery in 38 women undergoing hysterectomy. One group received IV morphine in the recovery room and IM morphine on the ward on a PRN basis (PRN group). In the other group, a loading dose of morphine 8 mg IV was given when the patient first complained of pain and patient-controlled IV morphine (PCA) was initiated and continued for 48 h (PCA group). Both groups received similar amounts of morphine overall, differently distributed over time. The PCA patients received 8 mg.h-1 in the recovery room (approximately 2.5 hrs) and less thereafter. The PRN patients received approximately 2 mg.h-1 for the entire 48-hr period. Pain control was better throughout convalescence and less variable across time with PCA management. Minute ventilation also recovered faster and by day four was 25 per cent above the preoperative baseline in the PCA group. In addition, oral temperature became normal one day earlier, ambulation recovered more rapidly and patients were discharged from hospital earlier. The data suggest that early treatment with relatively high, self-titrated morphine doses may alter the course of the metabolic response to surgery.
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PMID:Reduction of postoperative morbidity following patient-controlled morphine. 222 86

Management of postoperative pain has been shown to be inadequately controlled, and, in fact, can have significant deleterious effects on a patient's early postoperative recovery. Continuous epidural analgesia has recently been used to control postoperative pain. This mode of analgesia controls postoperative pain without the delays inherent in the PRN administration of systemic narcotics. This was a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 53 thoracic and 81 abdominal surgery patients. The focus of the study was to identify the benefits and problems of continuous epidural analgesia for postoperative pain management and the implications for the nursing care of the patients. Evaluation of the effectiveness of the analgesia was based on the following measures: (1) pain measured at regular intervals in the 72-hour period with a visual analog; (2) pain as measured after 72 hours with the word descriptor section of the McGill Pain Questionnaire; (3) amount of supplemental systemic narcotic analgesic needed; (4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; (5) occurrence of adverse effects; and (6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used (PRN) systemic administration of narcotics. With the exception of the report of back pain by patients receiving the normal saline epidural solution, complications did not occur in a significantly greater proportion when using the epidural route. Although some nursing care problems were identified, patients who received epidural analgesia were able to be cared for on general care units with no adverse effects reported.
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PMID:Efficacy of continuous epidural analgesia and the implications for patient care in the early postoperative phase. 228 19

Conducted chart review study of 114 4- to 14-year-olds hospitalized for elective surgery to investigate analgesic medication patterns. Correcting for body weight and different drug potencies, correlations were examined between analgesics, child age, painfulness of recovery, and seriousness of surgical procedure. Weight-adjusted analgesics prescribed and delivered PRN were unrelated to painfulness of procedure and age. Expert ratings of the seriousness of anticipated sequelae were found to be a modest but significant predictor of analgesics. Results suggest that PRN prescription of analgesics in children essentially guarantees very low drug delivery without achieving individualized pain management. Possible interpretations and suggestions for research into effects of practitioner attributions of seriousness on clinical decision making are discussed, along with implications for other explanations of inadequate analgesic practices.
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PMID:Patterns of PRN analgesic drug administration in children following elective surgery. 257 90

During a trimester time-course, pain and the efficiency of analgesic interventions were carefully analyzed over 4 weeks in 50 consecutive medical oncology patients with chronic cancer pain. Pain self-assessment was performed with help of a semi-verbal linear analogue scale (VAS). During the initial hospital stay a mean reduction in pain intensity of "40-50%" on VAS in (largely insufficiently pretreated) cancer patients was recorded within 3-7 days. Optimizing pain therapy was not accompanied by more prominent side-effects from more potent analgesic measures, which consisted in regular "pain prophylaxis" instead of PRN-orders, more frequent use of analgesics with a central analgesic action, combination of analgesics with antidepressants or neuroleptic agents and diligent use of still available potentially effective causal pain relief from palliative chemo-hormonotherapy, irradiation and supportive surgery. The (most frequent) skeletal pain situations were usually managed effectively by prostaglandin-synthetase inhibitors, and also by liberal use of palliative antitumor therapy. Visceral cancer pain was more effectively controlled by analgesics only (opiates/opioids). Strong emphasis is placed on critical interpretation of VAS pain scores and on concomitant psychosocial issues.
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PMID:[The course of pain following hospital admission of patients with chronic tumor pain]. 279 29

Successful management of pain can be accomplished in nearly all terminally ill patients. Pain must be assessed in terms of its physical, psychological and social components. Spiritual care and control of environmental factors are just as important as drug therapies. Once the cause of the pain is identified, an individualized plan of treatment can be developed. Nondrug therapies are tried first. When drugs must be used, the pain is treated by regular dosing to prevent recurrent breakthroughs--no PRN orders are used. The pain is blocked and its memory erased so that continued, uninterrupted relief is given. Drug management should provide ease of administration to maintain patient independence, unclouded and normal affect, and minimal troublesome side effects. Anticipatory treatment of expected problems with constipation and nausea should be done. By using a reproducible pain measurement scale, titration of drugs is carried out in a stepwise fashion, increasing dosage or potency until the desired effect is achieved. With multimode therapy, no patient should have to suffer the aching/agony pain cycle of terminal illness with cancer.
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PMID:Pain management. 288 74

A clinical study examining the efficacy of Patient Controlled Analgesia compared with Intramuscular Analgesia was conducted. Patient Controlled Analgesia (PCA) Therapy was used in a select group of patients after major abdominal surgery. Specific parameters monitored were: total amount of analgesia required, incidence of pulmonary complications, assessment of pain level and sedation, patient activity, nursing time required for administration, safety, cost-effectiveness of both modes of analgesia and length of hospital stay. A questionnaire survey of both patients and nursing staff was done to evaluate responses. Conventional pain management often is inadequate with PRN administration of analgesic drugs due to the unpredictable and uneven patient absorption rate and the individual pain intensity and tolerance. The patient experiences a repetitive cycle of pain and sedation. The patient on PCA therapy is able to titrate his analgesic medication very effectively and maintain a state of analgesia without sedation. He is more responsive and able to participate in the early postoperative rehabilitation phase. The transition to oral medication usually was accomplished at 48 hours postoperative.
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PMID:A study of pain management: patient controlled analgesia versus intramuscular analgesia. 292 58

While nonpharmacological treatment of migraine and tension headache has increasingly been demonstrated to be efficacious, relatively little attention has been focused upon treatment of the more severe cluster headache. This has particularly been the case for the type of cluster headache known as chronic cluster. The present case study focused upon the treatment of a 69-year-old male with a 37-year history of headache activity. The description of headache matched those criteria currently considered to be indicative of chronic cluster headache. Following 6 weeks of baseline, during which daily ratings of head pain and daily ingestion of "as needed" (PRN) pain medication were collected, a 7-week treatment phase was implemented. Treatment consisted of thermal biofeedback coupled with a spouse contingency program (i.e., directing the spouse to avoid consequating subject reports of head pain). During the treatment phase, a near-100% reduction in amount of weekly PRN pain medication ingested was noted, along with a decrease in self-reports of head pain. Both of these decreases were maintained at 1-month, 4-month, and 15-month follow-ups. Implications for treatment of chronic cluster headache were discussed.
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PMID:Behavioral treatment of chronic cluster headache in a geriatric patient. 650 10

Postoperative pain remains undertreated. Barriers to adequate postoperative analgesia include lack of knowledge regarding pain and its management, inadequate assessment, preconceived notions by nurses and physicians regarding pain and addiction, and the continued use of PRN administration of medications instead of active intervention on a scheduled basis. Knowledge regarding the physiology of pain provides nurses with information necessary to control pain. Pharmacologic management includes the use of nonopioids, opioids, and various adjuvant drugs. Principles regarding the use of these analgesics guide the nurse to use these drugs to their greatest effect. The special needs of the very young and the elderly must also be considered.
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PMID:Pharmacologic management of acute pain in the orthopaedic patient. 787 Apr 75


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