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Pain Management Ethics

Maria Claudia Rodríguez, Perla Villamor, Tatiana Castillo
INTRODUCTION: Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction...
November 2016: International Journal of Pediatric Otorhinolaryngology
Nao Tamai, Yuko Mugita, Mari Ikeda, Hiromi Sanada
PURPOSE: Skin metastasis is one of the most frequent metastases in breast cancer patients. Patients with malignant wounds experience numerous symptoms, including serious wound pain. However, the features of pain related to malignant wounds have not been investigated. Nurses can experience a dilemma when treating these patients due to a lack of knowledge of the pain. The aims of this study were to examine the quality and intensity of malignant wound pain and to determine the association between wound status and pain in the patients with malignant wounds...
October 2016: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
Mohammad Reza Pourahmadi, Morteza Taghipour, Ismail Ebrahimi Takamjani, Mohammad Ali Sanjari, Mohammad Ali Mohseni-Bandpei, Abbas Ali Keshtkar
INTRODUCTION: Lumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH...
September 27, 2016: BMJ Open
Ahmed H Othman, Ahmad M Abd El-Rahman, Fatma El Sherif
BACKGROUND: Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. OBJECTIVES: This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. STUDY DESIGN: A randomized, double-blind, prospective study...
September 2016: Pain Physician
Melanie B Morillon, Lisa Stamp, William Taylor, Jaap Fransen, Nicola Dalbeth, Jasvinder A Singh, Robin Christensen, Marissa Lassere
INTRODUCTION: Gout is the most common inflammatory arthritis in men over 40 years of age. Long-term urate-lowering therapy is considered a key strategy for effective gout management. The primary outcome measure for efficacy in clinical trials of urate-lowering therapy is serum urate levels, effectively acting as a surrogate for patient-centred outcomes such as frequency of gout attacks or pain. Yet it is not clearly demonstrated that the strength of the relationship between serum urate and clinically relevant outcomes is sufficiently strong for serum urate to be considered an adequate surrogate...
2016: BMJ Open
Karina J Lewis, Leo Ross, Michel W Coppieters, Bill Vicenzino, Annina B Schmid
INTRODUCTION: Carpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in public health systems create delays in accessing treatment for this condition. Alternative care pathways aimed at streamlining access to treatment and reducing the need for surgical intervention warrant further investigation. METHODS: A randomised, single-blind controlled clinical trial will be conducted...
2016: BMJ Open
Khuthala Mnika, Gift D Pule, Collet Dandara, Ambroise Wonkam
Sickle cell disease (SCD) is a blood disease caused by a single nucleotide substitution (T > A) in the beta globin gene on chromosome 11. The single point mutation (Glu6Val) promotes polymerization of hemoglobin S (HbS) and causes sickling of erythrocytes. Vaso-occlusive painful crises are associated with recurrent and long-term use of analgesics/opioids and hydroxyurea (HU) by people living with SCD. The present analysis offers a state-of-the-art expert review of the effectiveness of pharmacogenomics/genetics of pain management in SCD, with specific focus on HU and opioids...
October 2016: Omics: a Journal of Integrative Biology
Sarah A Warby, Jon J Ford, Andrew J Hahne, Lyn Watson, Simon Balster, Ross Lenssen, Tania Pizzari
INTRODUCTION: The most commonly recommended treatment for multidirectional instability (MDI) of the shoulder is exercise. Despite this recommendation, there is limited evidence to support the effectiveness of exercise. The aim of this paper is to describe a pilot randomised controlled trial comparing the effectiveness of 2 exercise programmes on outcomes of participants with MDI. METHODS AND ANALYSIS: Consenting participants between 12 and 35 years, with non-traumatic MDI will be randomly allocated to participate in either the Rockwood Instability programme or the Watson MDI programme...
September 12, 2016: BMJ Open
Mathieu Fontaine, Jacques Latarjet, Jacqueline Payre, Jean-Charles Poupelin, François Ravat
INTRODUCTION: The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. PATIENTS AND METHODS: Cohort study began after favorable opinion from local ethic committee has been collected...
September 6, 2016: Burns: Journal of the International Society for Burn Injuries
J Downing, R Kiman, S Boucher, B Nkosi, B Steel, C Marston, E Lascar, J Marston
The International Children's Palliative Care Network held its second international conference on children's palliative care in Buenos Aires, Argentina, from the 18th-21st May 2016. The theme of the conference was 'Children's Palliative Care…. Now!' emphasising the need for palliative care for children now, as the future will be too late for many of them. Six pre-conference workshops were held, addressing issues connected to pain assessment and management, adolescent palliative care, ethics and decision-making, developing programmes, the basics of children's palliative care, and hidden aspects of children's palliative care...
2016: Ecancermedicalscience
Phillippa Burnell, Rachael Coates, Steven Dixon, Lucy Grant, Matthew Grey, Ben Griffiths, Mike Jones, Anantha Madhavan, Iain McCallum, Ross McClean, Karen Naru, Lydia Newton, Paul O'Loughlin, Fadlo Shaban, Anisha Sukha, Sameer Somnath, Syed Shumon, Deena Harji
INTRODUCTION: Laparoscopic surgery combined with enhanced recovery programmes has become the gold standard in the elective management of colorectal disease. However, there is no consensus with regard to the optimal perioperative analgesic regime in this cohort of patients, with a number of options available, including thoracic epidural spinal analgesia, patient-controlled analgesia, subcutaneous and/or intraperitoneal local anaesthetics, local anaesthetic wound infiltration catheters and transversus abdominis plane blocks...
2016: BMJ Open
D Thapa, V Ahuja, P Verma, S Gombar, R Gupta, D Dhiman
BACKGROUND AND OBJECTIVES: Intermittent boluses for neural blockade provide better post-operative analgesia when compared to continuous infusion. However, these techniques of administration have not yet been compared while performing adductor canal block (ACB). We compared intermittent vs. continuous ACB for managing post-operative pain following anterior cruciate ligament (ACL) reconstruction. The primary endpoint was total morphine consumption for 24 h post-operatively in both the groups...
November 2016: Acta Anaesthesiologica Scandinavica
Richard B L Lim
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline...
October 2016: Therapeutic Advances in Respiratory Disease
Amit Sharad Chandra Bidwai, Ann Birch, David Temperley, Saurabh Odak, Michael J Walton, John F Haines, Ian Trail
BACKGROUND: We report on the medium- to long-term results of a randomized controlled trial (RCT) aiming to determine whether rotator cuff repair confers any advantage over arthroscopic sub-acromial decompression (ASAD) alone in the management of medium-sized rotator cuff tears. METHODS: Ethical approval was sought to follow-up patients previously enrolled in a completed and previously published RCT comparing the outcome of ASAD with mini-open cuff repair for the treatment of rotator cuff tear...
April 2016: Shoulder & Elbow
Lee Nedkoff, Matthew Knuiman, Michael S T Hobbs, Joseph Hung, Sushma Mathur, John Beilby, Anna Reynolds, Tom G Briffa, Derrick Lopez, Frank M Sanfilippo
INTRODUCTION: Accurate monitoring of acute coronary heart disease (CHD) is essential for understanding the effects of primary and secondary prevention and for planning of healthcare services. The ability to reliably monitor acute CHD has been affected by new diagnostic tests for myocardial infarction (MI) and changing clinical classifications and management of CHD. Our study will develop new and reliable methods for monitoring population trends in incidence, outcomes and health service usage for acute CHD and chest pain...
August 24, 2016: BMJ Open
Deniz Öztürk, Zehra Gocmen Baykara, Ayise Karadag, Evrim Eyikara
AIM AND OBJECTIVES: To evaluate the efficacy of applying manual pressure before intramuscular injection and compare it with the standard injection technique in terms of reducing the young adult student's post-injection pain. BACKGROUND: The administration of intramuscular injections is a procedure performed by nurses and one that causes anxiety and pain for the patient. Nurses have ethical and legal obligations to mitigate injection-related pain and the nurses use of effective pain management not only provides physical comfort to the patients, it also improves the patients' experience...
August 18, 2016: Journal of Clinical Nursing
Alain Serrie
Pain is a real issue of public health, quality and evolution of a system of health test: this is a major social problem. Pain management meets a humanistic, ethical purpose and dignity of man because of the physical and psychological implications. It induces a disability which excludes the patient of society gradually or suddenly. The physical pain and mental suffering to all ages of life make more vulnerable people weakened by disease. Rebel chronic pain are sources of disability, disabilities, disability and major alterations in the quality of life...
April 2015: Bulletin de L'Académie Nationale de Médecine
Santosh Kumar, Ajay Kumar Chaudhary, Prithvi Kumar Singh, Reetu Verma, Girish Chandra, Vinod Kumar Bhatia, Dinesh Singh, Jaishri Bogra
INTRODUCTION: Buprenorphine is a semi-synthetic derivative of thebaine; its low concentration is sufficient to provide effective pain relief. AIM: To evaluate the efficacy of transdermal buprenorphine patch in postoperative pain management. MATERIALS AND METHODS: After ethical approval and taking informed consent from the patients, they were randomized into three groups (n=30 in each group) using a computer generated random number table. Group A: placebo patch; Group B: buprenorphine (10mg) patch and Group C: buprenorphine (20mg) patch...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
Nardin Samuel, Mark Bernstein, Naif M Alotaibi, Suneil K Kalia, Mohammed F Shamji
OBJECTIVE: The aim of this study is to better understand perspectives of patients with persistent postoperative neuropathic pain (PPNP) and assess perceptions of the ethical issues surrounding their structural spinal surgeon also performing spinal cord stimulation (SCS). METHODS: Semistructured face-to-face interviews with 20 neurosurgical spine patients were conducted. Patients were recruited from the neurosurgery clinics at Toronto Western Hospital and were seen in consultation for PPNP...
August 5, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Vicki D Lachman
Moral resilience is the ability to deal with an ethically adverse situation without lasting effects of moral distress and moral residue. This requires morally courageous action, activating needed supports and doing the right thing. Morally resilient people also have developed self-confidence by confronting such situations so they can maintain their self-esteem, no matter what life delivers. Finally, the ability to adapt to changing circumstances with a sense of humor is at the heart of their flexibility. Morally resilient nurses are not naïve about the price of moral integrity...
March 2016: Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses
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