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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An acute pain service (APS) was set up to improve pain management after operation. We attempted to reduce the length of stay in the intensive care unit (ICU) of patients undergoing major surgery and to improve their homeostasis and rehabilitation using a multimodal approach (pain relief, stress reduction, early extubation). Patient-controlled epidural analgesia (PCEA) was a keystone of this approach. If PCEA was not applicable, patients received patient-controlled intravenous analgesia (PCIA) instead. Brachial plexus blockade (BPB) was used for surgery of the upper limbs. A computer based documentation system was used to help evaluate prospectively (a) the quality of analgesia, (b) adverse effects and risks of the special pain management techniques, and (c) cost-effectiveness. Patients receiving PCEA (n = 5.602) received a patient-titrated continuous infusion into the epidural space of either bupivacaine 0.175% or ropivacaine 0.2%, with 1 microg sufentanil mL(-1) added, followed by patient-controlled boluses of 2 mL (lockout time 20 min). For patients receiving PCIA (n = 634) an initial bolus of 7.5-15 mg piritramide was given, and the subsequent bolus was 2 mg (lockout time 10 min). A continuous infusion of bupivacaine 0.25% was administered to patients receiving BPB (n = 113). The dose was titrated to a dynamic visual analogue scale (VAS) scores < 40. The mean treatment periods were: BPB = 4.33 days, PCEA = 5.6 days, PCIA = 5.0 days. In the case of PCEA, the quality of pain relief, vigilance and satisfaction were superior compared with the PCIA method, which resulted in greater sedation and nausea. Although personal supervision was higher for the PCEA-treated patients, cost analysis revealed final savings of Euro 91,620 for the year 1998 obviating the need for an ICU stay totalling 433 days. Provided that PCEA is part of a fast-track protocol employing early tracheal extubation and optimal perioperative management, the associated initial higher costs will be recouped by the benefits to patients of better pain relief after surgery and fewer days subsequently spent in the ITU.
Eur J Anaesthesiol 2000 Sep
PMID:Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients. 1102 24

The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of Institution, are the procedures of a growing integrated program for postoperative pain treatment. The organizational processes should interact effectively with a plan of education, updating, revision and information in a definite development timing. It should be emphasized a collaborative, interdisciplinary approach to pain control, assessment and treatment, including all the members of the health care team, with an input from the patient and a protective collaboration from the Institution. The development of a postoperative care team must be considered as part of the largest project for "a Painfree Hospital". It represents a keystone of a Institutional Quality Assurance Plan for health care providers, patients (customs) and Institution.
Minerva Anestesiol 2000 Sep
PMID:[Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy]. 1107 Sep 58

Acute pain management is a complex process that requires nurses to rethink current practices. This paper details the barriers confronting nurses as they attempt to provide effective, acute pain management. An exploration of these barriers reveals the misconceptions commonly associated with opioid analgesic use and factors affecting pain assessment.
Contemp Nurse 1999 Sep
PMID:Can we get it right? Barriers to effective acute pain management with opioid analgesics. 1113 4

It is well established that muscarinic cholinergic agonists produce antinociceptive effects in a number of acute pain models. However, relatively little is known about the effects of muscarinic receptor agonists in models which involve central sensitization in pain pathways. The purpose of the present studies was to evaluate the effects of vedaclidine, a muscarinic receptor mixed agonist/antagonist across receptor subtypes, in models involving central sensitization. Vedaclidine (0.3-10 mg/kg s.c.) produced dose-related antihyperalgesic effects in the formalin test as well as a dose-related reversal of capsaicin-induced mechanical hyperalgesia in rats. In the carrageenan test, vedaclidine (0.1-30 mg/kg) produced a dose-related reversal of both mechanical and thermal hyperalgesia that were antagonized by the muscarinic receptor antagonist scopolamine. In addition, the antihyperalgesic effects of vedaclidine in the carrageenan test were synergistic with the antihyperalgesic effects of the non-steroidal antiinflammatory drug ketoprofen, as demonstrated by isobolographic analysis. The present studies demonstrate that vedaclidine produces antihyperalgesic effects in models involving central sensitization, suggesting that vedaclidine, and potentially other muscarinic receptor agonists, may have clinical utility in the management of pain states involving central sensitization, such as neuropathic and inflammatory pain states.
Pain 2001 Sep
PMID:Antihyperalgesic effects of the muscarinic receptor ligand vedaclidine in models involving central sensitization in rats. 1151 81

Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness, and necessary medical procedures. It is associated with increased anxiety, avoidance, somatic symptoms, and increased parent distress. Despite the magnitude of effects that acute pain can have on a child, it is often inadequately assessed and treated. Numerous myths, insufficient knowledge among caregivers, and inadequate application of knowledge contribute to the lack of effective management. The pediatric acute pain experience involves the interaction of physiologic, psychologic, behavioral, developmental, and situational factors. Pain is an inherently subjective multifactorial experience and should be assessed and treated as such. Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.
Pediatrics 2001 Sep
PMID:The assessment and management of acute pain in infants, children, and adolescents. 1153 54

This article presents the current management of acute pain(posttraumatic and postoperative pain). The management of acute pain, especially postoperative pain, makes a great advance in this twenty years. The discovery of physiology and pharmacology of pain mechanisms made a great contribution to the improvement of the patient care during postoperative period. The following three events seem to be a tremendous impact for this improvement, 1) spinal opioid, 2) preemptive analgesia, 3) patient-controlled analgesia(PCA). So these days postoperative pain, the major complaint during the postoperative period, is almost improved at the hospital that coordinates pain treatment strategies. The management of pain improves the quality of life for the postoperative patients and the prognosis of postoperative patients. We should take our warning to heart that the management of acute pain(postoperative, posttraumatic, and labor pain) is not only 'procedure' but also 'therapy' against the pain.
Nihon Rinsho 2001 Sep
PMID:[Posttraumatic/postoperative pain]. 1155 48

Non-opioid analgesics such as NSAIDs play a central role for patients with cancer pain as well as for those with acute pain. Pain management using non-opioid analgesics need to avoid potential side effects, and the analgesic action of NSAIDs, cyclooxygenase inhibitors, would synergistically potentiate opioids' effects via the activation of the periaquaductal grey of the midbrain. The analgesic action of opioids would also be potentiated by the activation of alpha 2-adrenoceptors of the spinal cord. Thus the use of non-opioid analgesics for cancer patients taking opioid needs meticulous care. Undertreatment of pain is a persistent clinical problem for patients with cancer. Although changing medical practice is difficult and improving pain management with the rational use of combination of drugs may especially difficult, supplementation of non-opioid analgesics for opioid treatment would provide a better quality of life of cancer patients.
Nihon Rinsho 2001 Sep
PMID:[Non-opioid analgesics in cancer pain]. 1155 55

To effectively treat acute pain, emergency medicine practitioners must have a thorough understanding of both the pathophysiology and terminology of the pain experience. The pathophysiology of pain is discussed with an emphasis on the mechanisms of acute, inflammatory pain. The various types of pain receptors, pathways and neurotransmitters are also discussed.
Emerg Med (Fremantle) 2001 Sep
PMID:Pathophysiology of acute pain: implications for clinical management. 1155 56

The rational approach to acute pain management is to use the highest quality evidence available. Acute pain management is more than a collection of interventions. It is a package of care that needs to be examined as a whole as well as in its parts. In the context of acute pain management, this comes from systematic reviews of valid randomised trials. We still have to adapt to the circumstances of the individual, but our policies will be more discerning. Acute pain is not confined to postoperative wards but it is a problem in many clinical settings. Educational programs for allied health professionals are equally important because they play the key role in the management of acute pain. Accreditation and educational programs in individual institutions would enable the nurses to identify their learning needs, to acquire appropriate knowledge and skills to ensure that they are adequately prepared for the responsibilities involved in pain management. The key of successful pain management is education, not new drugs or high-tech delivery systems. Existing tools can do the job if doctors and nurses are educated, both to dispel the myths and misconceptions and to take responsibility for providing pain control. It is much easier to dispel myths when you have the evidence. In 1846, the first anaesthetic provided pain-free surgery - 150 years later patients should not have to endure unrelieved pain anywhere in the hospital.
Minerva Anestesiol 2001 Sep
PMID:Pain free hospital: organisation aspects. 1177 15

Over the past few years, increasing emphasis has been placed on the need to improve the management of acute pain. Despite a growing trend in acute pain management, many difficulties are still present for the treatment of postoperative pain. Loco-regional techniques together with an effective pain management should accelerate rehabilitation, decrease risk of postoperative complications and speed return to normal activities. A multimodal approach should be used for a reduction of pharmacological side effects, improving pain reduction. The association between NSAIDs and opioids permits reduction of full dose opioids with better pain relief and less side effects. If NSAIDs are contraindicated, acetaminophen is an alternative, though considered by someone to be an NSAID It's action is believed to result from inhibition of prostaglandin synthesis within the central nervous system. It doesn't cause gastrointestinal ulceration or bleeding, but we have to note that large amounts may lead to hepatic necrosis. Newer NSAIDs (COX-2 inhibitors), affect mainly COX-2, and appear to be associated with less adverse effect. Rofecoxib showed a reduction of morphine consuming after spinal fusion and has been admitted by FDA for the treatment of post operative pain. Newer methods of pain relief, as patient controlled analgesia (PCA), can provide excellent and safe pain relief. When high-tech options such as PCA are used, patients need a management by an anesthesiologist-based acute pain service (APS), allowing a better pain relief with less side effects compared to patients supervised by less experienced medical staff.
Minerva Anestesiol 2001 Sep
PMID:[Systemic analgesia after peripheral block]. 1177 17


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