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Pain Management Ethics

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https://www.readbyqxmd.com/read/28550589/carbon-dioxide-co2-angiography-as-an-option-for-endovascular-abdominal-aortic-aneurysm-repair-evar-in-patients-with-chronic-kidney-disease-ckd
#1
Chiara De Angelis, Francesco Sardanelli, Matteo Perego, Marco Alì, Francesco Casilli, Luigi Inglese, Giovanni Mauri
To assess feasibility, efficacy and safety of carbon dioxide (CO2) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6 ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0 ± 8.0 mm. CO2 angiography was performed by automatic (n = 7) or hand (n = 6) injection...
May 27, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28543418/reconciling-patient-safety-and-epistemic-humility-an-ethical-use-of-opioid-treatment-plans
#2
Anita Ho
In this issue of the Hastings Center Report, Joshua Rager and Peter Schwartz suggest using opioid treatment agreements as public health monitoring tools to inform patients about "the requirements entailed by undergoing opioid therapy," rather than as contractual agreements to alter patients' individual behavior or to benefit them directly. Because Rager and Schwartz's argument presents suspected OTA violations as a justification to stop providing opioids yet does not highlight the broader epistemic and systemic context within which clinicians prescribe these medications, their proposal may perpetuate a climate of distrust and stigmatization without correcting systemic factors that may have placed patients and others at risk in the first place...
May 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28501812/integrating-culturally-informed-approaches-into-the-physiotherapy-assessment-and-treatment-of-chronic-pain-protocol-for-a-pilot-randomised-controlled-trial
#3
Bernadette Brady, Irena Veljanova, Siobhan Schabrun, Lucinda Chipchase
INTRODUCTION: There is strong evidence that biopsychosocial approaches are efficacious in the management of chronic pain. However, implementation of these approaches in clinical practice is known not to account for the beliefs and values of culturally and linguistically diverse (CALD) patients. This limitation in translation of research contributes to the disparities in outcomes for CALD patients with chronic pain adding to the socioeconomic burden of this prevalent condition. Cultural adaptation of chronic pain assessment and management is urgently required...
May 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28494906/the-effect-of-morphine-added-to-bupivacaine-in-ultrasound-guided-transversus-abdominis-plane-tap-block-for-postoperative-analgesia-following-lower-abdominal-cancer-surgery-a-randomized-controlled-study
#4
Fatma Adel El Sherif, Sahar Abdel-Baky Mohamed, Shereen Mamdouh Kamal
OBJECTIVES: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery. STUDY DESIGN: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. SETTING: Academic medical center...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28486096/key-pharmacogenomic-considerations-for-sickle-cell-disease-patients
#5
Alexandra Kolliopoulou, Apostolos Stratopoulos, Stavroula Siamoglou, Argyro Sgourou, Adamantia Papachatzopoulou, Theodora Katsila, George P Patrinos
Sickle cell disease (SCD), although a monogenic disease, exhibits a complex clinical phenotype that hampers optimum patient stratification and disease management, especially on hydroxyurea treatment. Moreover, theranostics, the combination of diagnostics to individualize and optimize therapeutic interventions, has not been firmly on the forefront of SCD research and clinical management to date. We suggest that if tailor-made theranostics in SCD is envisaged, pharmacogenomics is anticipated to be the way forward...
May 9, 2017: Omics: a Journal of Integrative Biology
https://www.readbyqxmd.com/read/28473517/what-is-the-best-analgesic-option-for-patients-presenting-with-renal-colic-to-the-emergency-department-protocol-for-a-systematic-review-and-meta-analysis
#6
Sameer A Pathan, Biswadev Mitra, Lorena Romero, Peter A Cameron
INTRODUCTION: Patients with renal colic present to the emergency department in excruciating pain. There is variability in practice regarding the choice of initial analgesic to be used in renal colic. The aim of this article is to outline the protocol for review of the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol use in renal colic pain management. METHODS AND ANALYSIS: This is the protocol for a systematic review, comparing efficacy of NSAIDs, opioids and paracetamol in renal colic studied under randomised controlled trial (RCT) design...
May 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28462897/radiation-oncology-resident-palliative-education
#7
Monica Krishnan, Margarita Racsa, Joshua Jones, Eva Chittenden, Kristen G Schaefer, Alex Spektor, Andrea Enzinger, Randy Wei, Tracy Balboni
PURPOSE: Although palliative care is recognized as integral to oncology care, limited data exist regarding the extent to which palliative care training is incorporated into radiation oncology residency training in the United States. We aim to characterize US radiation oncology residents' perceived palliative care educational needs and experience to guide future palliative oncology educational interventions. METHODS AND MATERIALS: An 8-person expert panel developed a survey to assess resident perceptions of generalist palliative care education within radiation oncology residency...
March 14, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28460701/effective-management-of-pain-and-anxiety-for-the-pediatric-patient-in-the-emergency-department
#8
REVIEW
Virginia B Young
Inadequate treatment of pain for children in the emergency department is a persistent problem. Health care professionals are bound by ethical principles to provide adequate pain management; in children, this may be challenging owing to cognitive and developmental differences, lack of knowledge regarding best practices, and other barriers. Studies have concluded that immediate assessment, treatment, and reassessment of pain after an intervention are essential. Self-report and behavioral scales are available...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28445263/acupuncture-for-enhancing-early-recovery-of-bowel-function-in-cancer-protocol-for-a-systematic-review
#9
Yi-Hua Liu, Yang Ye, Jia-Bin Zheng, Xue-Qian Wang, Ying Zhang, Hong-Sheng Lin
BACKGROUND: Cancer patients undergoing surgical procedure often suffer from bowel dysfunction and postoperative ileus (POI). Cancer management for early recovery of bowel function is still a challenging topic. Acupuncture has been commonly used in a variety of gastrointestinal diseases. The aim of this study is to evaluate the effects of acupuncture therapy to reduce the duration of POI and enhance bowel function in cancer patients. METHODS: We will systematically screen all randomized controlled trials (RCTs) published through electronically and hand searching...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28431539/pain-intervention-for-people-with-dementia-in-nursing-homes-pid-study-protocol-for-a-quasi-experimental-nurse-intervention
#10
Andrea Koppitz, Georg Bosshard, Geneviève Blanc, Hannele Hediger, Sheila Payne, Thomas Volken
BACKGROUND: It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home...
April 21, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28429143/how-to-treat-lumbar-disc-herniation-in-pregnancy-a-systematic-review-on-current-standards
#11
REVIEW
Alberto Di Martino, Fabrizio Russo, Luca Denaro, Vincenzo Denaro
PURPOSE: In this systematic review, we aim to illustrate the current and safe concepts in the assessment, diagnosis and management of herniated lumbar disc (HLD) during pregnancy. METHODS: A systematic review and reporting on the diagnosis, treatment and clinical results of HLD during pregnancy is performed. RESULTS: The MRI represents the first level and safest diagnostic tool for pregnant women affected by spinal problems allowing for a noninvasive and detailed radiological examination of the spine...
April 20, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28409480/genetic-testing-for-opioid-pain-management-a-primer
#12
Deepti Agarwal, Mercy A Udoji, Andrea Trescot
Patients see their primary care physicians (PCPs) for a variety of medical conditions, chronic pain being one of the most common. An increased use of prescription medications (especially opioids) has led to an increase in adverse drug reactions and has heightened our awareness of the variability in response to medications. Opioids and other pain adjuvants are widely used, and drug-drug interactions involving these analgesics can be problematic and potentially lethal. Pharmacogenetics has improved our understanding of drug efficacy and response, opened doors to individual tailoring of medical management, and created a series of ethical and economic considerations...
April 13, 2017: Pain and Therapy
https://www.readbyqxmd.com/read/28383311/musculoskeletal-pain-profile-of-obese-individuals-attending-a-multidisciplinary-weight-management-service
#13
Grace A MacLellan, Colin Dunlevy, Emer O'Malley, Catherine Blake, Cathy Breen, Karen Gaynor, Natalie Wallace, Ruth Yoder, Domhnall Casey, John Mehegan, Donal O'Shea, Brona M Fullen
Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which impacts on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study utilized a patient database at a national weight management service (WMS). Following ethical approval, anonymized patient data were statistically analyzed to develop a pain profile, investigate relationships between pain, sleep, and function, and explore variables associated with having low back pain (LBP) and knee pain...
April 5, 2017: Pain
https://www.readbyqxmd.com/read/28351829/innovations-in-the-management-of-musculoskeletal-pain-with-alpha-lipoic-acid-impala-trial-study-protocol-for-a-double-blind-randomized-placebo-controlled-crossover-trial-of-alpha-lipoic-acid-for-the-treatment-of-fibromyalgia-pain
#14
Ian Gilron, Dongsheng Tu, Ronald Holden, Tanveer Towheed, Dan Ziegler, Louie Wang, Roumen Milev, Christopher Gray
BACKGROUND: Fibromyalgia is a common disorder characterized by chronic widespread pain, sleep disturbance, fatigue, depression, and cognitive dysfunction, resulting in substantial disability. As current analgesics provide incomplete relief and disabling side effects that aggravate fatigue and cognitive dysfunction, there is a need for new pain treatments with better efficacy and tolerability. Alpha-lipoic acid (ALA) is an antioxidant proven effective in painful diabetic neuropathy with minimal side effects...
March 28, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28350202/outcomes-of-laparoscopic-cholecystectomy-for-biliary-dyskinesia-in-children
#15
Sarah W Lai, Steven S Rothenberg, Saundra M Kay, Kristin E Shipman, Bethany J Slater
PURPOSE: To determine the outcomes of laparoscopic cholecystectomy as a treatment for biliary dyskinesia in children. METHODS: With ethics approval, a retrospective chart review was performed on children (<21 years) at a single center diagnosed with biliary dyskinesia (defined as gallbladder ejection fraction [EF] <35% and/or pain with cholecystokinin [CCK] on cholescintigraphy, in the absence of gallstones or cholecystitis on ultrasound) and treated with laparoscopic cholecystectomy between March 2010 and February 2016...
March 28, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28298786/comparison-of-dexmedetomidine-and-magnesium-sulfate-as-adjuvants-with-ropivacaine-for-spinal-anesthesia-in-infraumbilical-surgeries-and-postoperative-analgesia
#16
Reena Makhni, Joginder Pal Attri, Payal Jain, Veena Chatrath
INTRODUCTION: Postoperative pain is a major cause of fear and anxiety in hospitalized patients and so if patients remain pain-free during this period, they can cooperate with the circumstances well, leading to early recovery. Over the last two decades, there has been considerable revival of interest in the use of regional anesthesia techniques for surgery and pain management. As very few studies have been conducted using ropivacaine with dexmedetomidine and magnesium sulfate (MgSO4) as adjuvants, the present study was undertaken with primary aims to compare the hemodynamic stability, onset and duration of sensory and motor block and with secondary aims of the postoperative analgesic effect of dexmedetomidine and MgSO4 along with ropivacaine...
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28259854/does-early-intervention-improve-outcomes-in-physiotherapy-management-of-lumbar-radicular-syndrome-a-mixed-methods-study-protocol
#17
Michael Reddington, Stephen J Walters, Judith Cohen, Susan Baxter
INTRODUCTION: Lumbar radicular syndrome (LRS) can be a painful and debilitating condition. The optimum management strategies and their timing remain elusive despite extensive research. Surgery provides good short-term outcomes but has concomitant risks and costs. Physiotherapy is commonly practised for patients with LRS but its effects remain equivocal and there is a lack of consensus on the type, duration and timing of physiotherapy intervention. There is a lack of high-quality evidence into new and innovative management strategies and the timings of those strategies for LRS...
March 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/28253407/culturally-responsive-pain-management-for-black-older-adults
#18
Sheria G Robinson-Lane, Staja Q Booker
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS XX contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo...
March 2, 2017: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/28248619/chewing-gum-vs-ibuprofen-in-the-management-of-orthodontic-pain-a-multi-centre-randomised-controlled-trial-the-effect-of-anxiety
#19
Anthony J Ireland, Pamela Ellis, Abbie Jordan, Rebecca Bradley, Paul Ewings, Nicola E Atack, Helen Griffiths, Kate House, Matthew B Moore, Scott Deacon, Nicholas Wenger, Victoria Worth, Emma Scaysbrook, Julie C Williams, Jonathan R Sandy
OBJECTIVES: Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. METHODS: 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief...
March 2017: Journal of Orthodontics
https://www.readbyqxmd.com/read/28236471/erectile-dysfunction-in-patients-with-chronic-pain-treated-with-opioids
#20
Raquel Ajo, Ana Segura, María-Del-Mar Inda, César Margarit, Pura Ballester, Emi Martínez, Guillermina Ferrández, Ángel Sánchez-Barbie, Ana M Peiró
INTRODUCTION AND OBJECTIVE: Chronic pain is associated with comorbidities that have an impact on the quality of life of patients and, among others, affect their sexual functioning. One of the most relevant side effects of opioid analgesics is erectile dysfunction (ED), due in part to the inhibition of the gonadal-pituitary-hypothalamic axis and the decline in testosterone levels. To evaluate ED and effectiveness of treatment in men with chronic pain treated with long-term opioids. MATERIAL AND METHODS: Prospective observational study lasting 3 years, where the intensity of pain (visual analogue scale, 0-10cm), erectile function (IIEF-EF, range 1-30 points), quality of life (EQ-VAS, 0-100mm), quality of sexual life (MSLQ-QOL, 0-100 points), anxiety/depression (HAD, 0-21 points) and testosterone levels, was assessed in patients who reported sexual dysfunction (ED or libido modification)...
February 21, 2017: Medicina Clínica
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