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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effectiveness of patient-controlled analgesia (PCA) depends upon the patient's appropriate response to a strong aversive stimulus (i.e., pain) with subsequent reinforcement (i.e., opiate injection). Each patient may have psychological characteristics that modify this response to aversive stimuli. To test for such characteristics, 76 female patients undergoing abdominal gynecologic procedures were given psychological tests (i.e., the Chance External, Powerful Others External, and Internal subscales of the Multidimensional Health Locus of Control; the Activities of Daily Living scale; and the Hypochondriasis, Depression, and Hysteria scales of the Minnesota Multiphasic Personality Inventory). Patients utilized PCA for postoperative analgesia. At the completion of PCA, patients were given a questionnaire assessing both the level of pain and degree of satisfaction with pain relief. Correlational analysis compared the level of pain and degree of satisfaction with results of psychological testing. Results showed that female patients with an external locus of control had higher levels of pain and greater dissatisfaction with PCA. An internal locus of control was predictive of lower pain scores and increased satisfaction. PCA effectiveness, as measured by the level of pain and degree of patient satisfaction, correlated with results of psychological testing. The delineation of these and other possible modifiers of PCA efficacy may define populations that are optimally responsive to PCA.
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PMID:Modifiers of patient-controlled analgesia efficacy. I. Locus of control. 281 51

Fifty-eight gynecologic surgical patients using patient-controlled analgesia (PCA) were given several psychological questionnaires and their pain was monitored postoperatively. Pain scores were recorded hourly on postoperative day 1. In addition, patients were asked to score retrospectively their overall pain experience while using PCA (Patient Overall Evaluation). Patients having had a history of pain for at least 6 months were considered to have 'chronic pain,' while those who had no history of chronic pain were grouped as 'acute pain' patients. Chronic pain patients spent more time in 'moderate' pain than did acute pain patients. While patients with a history of chronic pain had higher scores on the hourly pain scale compared to acute pain patients, there were no differences between the two groups on the Patient Overall Evaluation. In addition, chronic pain patients reported the same pain levels after completion of PCA as they did during its use, in contrast to acute pain patients whose retrospective pain levels were higher than during PCA use. Compared to acute pain patients, chronic pain patients had higher scores on both the Hypochondriasis and the Hysteria scales of the MMPI. A history of chronic pain may affect the use of patient-controlled analgesia since chronic pain patients may accommodate to a 'moderate' pain level which approximates their preoperative perception of pain. By contrast, acute pain patients who have no 'chronic pain experience' may self-administer pain medication so as to attain a predominately 'mild' level of pain.
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PMID:Modifiers of patient-controlled analgesia efficacy. II. Chronic pain. 281 52

This study was conducted in order to investigate the advantages and limitations of four analgesic modalities: a) epidural morphine; b) intravenous morphine; c) patient controlled intravenous morphine (patient-controlled analgesia); and d) non-steroidal anti-inflammatory drugs. Eighty patients undergoing major abdominal surgical procedures were prospectively and randomly treated with one of the above-mentioned analgesic methods. Evaluation of pain perception was done using the visual analogue pain score and the simple descriptive scale 4 hours after the procedure, in the early morning on postoperative day 1 and in the afternoon on postoperative days 1, 2 and 3. The need for supplementary analgesia and the onset of complications, if any, were also evaluated for each patient. Patient-controlled intravenous morphine yielded the best analgesic effect over the entire period. Epidural morphine was more effective in the very early postoperative period compared to modalities (b) and (d). Non-steroidal anti-inflammatory drugs, on the other hand, were more effective on the later postoperative days. None of the patients in group C needed supplementary analgesia, as against 20% in group A, 55% in group B and 40% in group D. Patients with hypochondriasis scores > 70 or depression scores > 70 required supplementation of analgesia more often. Morphine proved to be the drug of choice. Drug titration may be modulated in relation to the psychological characteristics of the patient. The best drug titration modality, in fact, is patient-controlled analgesia.
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PMID:A prospective randomized clinical trial on pain control after major abdominal surgery. 1293 92