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Pain Management Ethics

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https://www.readbyqxmd.com/read/28928570/gabapentinoids-as-a-part-of-multi-modal-drug-regime-for-pain-relief-following-laproscopic-cholecystectomy-a-randomized-study
#1
Anjali Kochhar, Kanika Chouhan, Pratibha Panjiar, Homay Vajifdar
BACKGROUND: Gabapentinoids have been used as preemptive analgesics for pain management following laparoscopic cholecystectomy. Recently, multimodal analgesic techniques have been found superior to preemptive analgesia alone. AIM: The aim of this study is to evaluate and compare a single preoperative dose of pregabalin 150 mg and gabapentin 300 mg for pain relief following laparoscopic cholecystectomy as a part of multimodal drug regime. SETTINGS AND DESIGN: This randomized, single-blind study was conducted after Ethical Committee approval and written informed consent from the patients...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28924315/comparison-between-continuous-thoracic-epidural-block-and-continuous-thoracic-paravertebral-block-in-the-management-of-thoracic-trauma
#2
Shalendra Singh, Mathews Jacob, S Hasnain, Mathangi Krishnakumar
BACKGROUND: Postoperative pain is thought to be the single most important factor leading to ineffective ventilation and impaired secretion clearance after thoracic trauma. Effective pain relief can be provided by thoracic epidural analgesia but may have side effects or contraindications. Paravertebral block is an effective alternative method without the side effects of a thoracic epidural. We did this study to compare efficacy of thoracic epidural and paravertebral block in providing analgesia to thoracic trauma patients...
April 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/28912191/high-versus-low-energy-administration-in-the-early-phase-of-acute-pancreatitis-goulash-trial-protocol-of-a-multicentre-randomised-double-blind-clinical-trial
#3
Katalin Márta, Anikó N Szabó, Dániel Pécsi, Péter Varjú, Judit Bajor, Szilárd Gódi, Patrícia Sarlós, Alexandra Mikó, Kata Szemes, Mária Papp, Tamás Tornai, Áron Vincze, Zsolt Márton, Patrícia A Vincze, Erzsébet Lankó, Andrea Szentesi, Tímea Molnár, Roland Hágendorn, Nándor Faluhelyi, István Battyáni, Dezső Kelemen, Róbert Papp, Attila Miseta, Zsófia Verzár, Markus M Lerch, John P Neoptolemos, Miklós Sahin-Tóth, Ole H Petersen, Péter Hegyi
INTRODUCTION: Acute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in its pathogenesis. Importantly, preclinical research has shown that intracellular ATP delivery restores the physiological function of the cells and protects from cell injury, suggesting that restoration of energy levels in the pancreas is therapeutically beneficial. Despite several high quality experimental observations in this area, no randomised trials have been conducted to date to address the requirements for energy intake in the early phase of AP...
September 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/28893753/a-randomised-controlled-trial-comparing-venous-stenting-with-conservative-treatment-in-patients-with-deep-venous-obstruction-research-protocol
#4
Timme Maj van Vuuren, Jorinde H H van Laanen, Maaike de Geus, Patty J Nelemans, Rick de Graaf, Cees H A Wittens
INTRODUCTION: Deep venous obstruction (DVO) has a great impact on quality of life (QoL) comparable to angina pectoris or chronic pulmonary disease. Post-thrombotic scar formation and May-Thurner syndrome (MTS) are the most common causes of DVO. Conventional treatment of DVO focuses on reducing pain or leg swelling by use of (pain) medication and therapeutic elastic stockings. In the past, a venous bypass was offered in severe post-thrombotic cases, but this procedure showed bad clinical and patency outcomes...
September 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28884750/brain-imaging-tests-for-chronic-pain-medical-legal-and-ethical-issues-and-recommendations
#5
REVIEW
Karen D Davis, Herta Flor, Henry T Greely, Gian Domenico Iannetti, Sean Mackey, Markus Ploner, Amanda Pustilnik, Irene Tracey, Rolf-Detlef Treede, Tor D Wager
Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way...
September 8, 2017: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/28871021/effectiveness-of-two-psychological-interventions-for-pain-management-emotional-regulation-and-promotion-of-quality-of-life-among-adult-portuguese-men-with-haemophilia-psy-haemopeq-study-protocol-for-a-single-centre-prospective-randomised-controlled-trial
#6
Patrícia Ribeiro Pinto, Ana Cristina Paredes, Patrício Costa, Manuela Carvalho, Manuela Lopes, Susana Fernandes, Susana Pedras, Armando Almeida
INTRODUCTION: Haemophilia is a bleeding disorder associated with significant pain, emotional distress, quality of life (QoL) impairment and considerable healthcare costs. Psychosocial health and effective pain management are considered essential end points for optimal haemophilia care, but there is a significant gap in evidence-based treatments targeting these outcomes in people with haemophilia (PWH). Psychological interventions are cost-effective in promoting emotional well-being, QoL and pain control, although these have been scarcely used in haemophilia field...
September 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/28851798/study-protocol-for-a-multi-institutional-randomised-double-blinded-placebo-controlled-phase-iii-trial-investigating-additive-efficacy-of-duloxetine-for-neuropathic-cancer-pain-refractory-to-opioids-and-gabapentinoids-the-direct-study
#7
Hiromichi Matsuoka, Hiroto Ishiki, Satoru Iwase, Atsuko Koyama, Takashi Kawaguchi, Yoshiyuki Kizawa, Tatsuya Morita, Yoshinobu Matsuda, Tempei Miyaji, Keisuke Ariyoshi, Takuhiro Yamaguchi
INTRODUCTION: Management of patients with cancer suffering from neuropathic pain refractory to opioids and gabapentinoids remains an important challenge. Duloxetine is one of the choices after first-line treatment fails. The efficacy of duloxetine has been reported in patients with non-cancer disease and in chemotherapy-induced peripheral neuropathy, but no randomised clinical trials have examined its effects on neuropathic cancer pain refractory to first-line treatment. The objective of this study is to assess the analgesic efficacy of duloxetine in patients suffering from neuropathic cancer pain refractory to opioids and gabapentinoids...
August 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/28809870/-case-report-iatrogenic-shoulder-pain-syndrome-following-spinal-accessory-nerve-injury-during-lateral-cervical-neck-dissection-for-tongue-cancer-the-role-of-rehabilitation-and-ethical-deontological-issues
#8
Gianpaolo Ronconi, Antonio Gioacchino Spagnolo, Giorgio Ferriero, Silvia Giovannini, Eugenia Amabile, Giulio Maccauro, Paola Emilia Ferrara
The shoulder pain syndrome is the most frequent complication of lateral cervical neck dissection and may be caused by iatrogenic injury to the spinal accessory nerve, causing pain and functional limitation of the upper limb and of the cervical spine. Interdisciplinary collaboration and early rehabilitation can reduce the consequences of disability and the possible issues that can arise due to inadequate management of the problem.
May 2017: Igiene e Sanità Pubblica
https://www.readbyqxmd.com/read/28780728/predictive-model-of-complexity-in-early-palliative-care-a-cohort-of-advanced-cancer-patients-palcom-study
#9
Albert Tuca, Mónica Gómez-Martínez, Aleix Prat
PROPOSAL: Model of early palliative care (PC) integrated in oncology is based on shared care from the diagnosis to the end of life and is mainly focused on patients with greater complexity. However, there is no definition or tools to evaluate PC complexity. The objectives of the study were to identify the factors influencing level determination of complexity, propose predictive models, and build a complexity scale of PC. PATIENTS AND METHOD: We performed a prospective, observational, multicenter study in a cohort of advanced cancer patients with an estimated prognosis ≤ 6 months...
August 6, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28780561/behaviour-change-interventions-for-the-management-of-raynaud-s-phenomenon-a-systematic-review-protocol
#10
Jo Daniels, John D Pauling, Christopher Eccelston
INTRODUCTION: Raynaud's phenomenon (RP) describes excessive peripheral vasospasm to cold exposure and/or emotional stress. RP episodes are associated with digital colour changes, pain and reduced quality of life. Pharmacological interventions are of low to moderate efficacy and often result in adverse effects such as facial flushing and headaches. Recommended lifestyle and behavioural interventions have not been evaluated. The objectives of the proposed systematic review are to assess the comparative safety and efficacy of behaviour change interventions for RP and identify what we can learn to inform future interventions...
August 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28754173/a-randomized-double-blind-placebo-controlled-trial-on-the-role-of-preemptive-analgesia-with-acetaminophen-paracetamol-in-reducing-headache-following-electroconvulsive-therapy-ect
#11
Amila Isuru, Asiri Rodrigo, Chamara Wijesinghe, Dileepa Ediriweera, Shan Premadasa, Carmel Wijesekara, Lalith Kuruppuarachchi
BACKGROUND: Electroconvulsive therapy (ECT) is a safe and efficient treatment for several severe psychiatric disorders, but its use is limited by side effects. Post-ECT headache is one of the commonest side effects. Preemptive analgesia is effective in post-surgical pain management. The most commonly used analgesic is acetaminophen (paracetamol). However, acetaminophen as a preemptive analgesic for post-ECT headache has not been studied adequately. This study was conducted to compare the incidence and severity of post-ECT headache in patients who were administered acetaminophen pre-ECT with a placebo group...
July 28, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28748395/variation-in-caries-treatment-proposals-among-dentists-in-norway-the-best-interest-of-the-child
#12
A Rønneberg, A B Skaare, B Hofmann, I Espelid
AIM: To explore variation in treatment-related-decisions for severe caries in children among dentists in the Public Dental Service (PDS) in Norway. It was also to evaluate the treatment choices in relation to the best interest of children and a child's rights to enjoy the highest standard of health care. METHODS: A pre-coded questionnaire was sent electronically to all general dental practitioners (GDPs) working in the PDS in eight counties in Norway (n = 611)...
July 26, 2017: European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry
https://www.readbyqxmd.com/read/28738744/pain-profiles-in-a-community-dwelling-population-following-spinal-cord-injury-a-national-survey
#13
Dearbhla Burke, Brona M Fullen, Olive Lennon
CONTEXT: While as many as 60% of patients with spinal cord injury (SCI) develop chronic pain, limited data currently exists on the prevalence and profile of pain post-SCI in community dwelling populations. STUDY DESIGN: A cross-sectional population survey. SETTING: Primary care. PARTICIPANTS: Community dwelling adults with SCI. METHODS: Following ethical approval members registered to a national SCI database (n=1,574) were surveyed...
July 24, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28722516/pre-operative-obesity-does-not-predict-poorer-symptom-control-and-quality-of-life-after-lumbar-disc-surgery
#14
Paul M Brennan, James J M Loan, Neil Watson, Pragnesh M Bhatt, Peter Alwyn Bodkin
PURPOSE: We aimed to determine whether there was a difference in post-operative symptomatic control and quality of life (QoL) between patients who were obese (BMI >30) and non-obese (BMI <30) pre-operatively. This information may inform the decision making of Physicians and patients whether to proceed to surgery for management of symptomatic lumbar disc prolapse. METHODS: We conducted a prospective questionnaire-based study of QoL and symptom control in 120 patients with postal follow-up at 3 and 12 months after lumbar disc surgery...
July 19, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28679640/palliative-sedation-with-propofol-for-an-adolescent-with-a-dnr-order
#15
Liza-Marie Johnson, Joel Frader, Joanne Wolfe, Justin N Baker, Doralina L Anghelescu, John D Lantos
Death from cancer is often painful. Usually, the pain can be relieved in ways that allow patients to remain awake and alert until the end. Sometimes, however, the only way to relieve pain is to sedate patients until they are unconscious. This method has been called palliative sedation therapy. Palliative sedation therapy is controversial because it can be misunderstood as euthanasia. We present a case in which an adolescent who is dying of leukemia has intractable pain. Experts in oncology, ethics, pain management, and palliative care discuss the trade-offs associated with different treatment strategies...
August 2017: Pediatrics
https://www.readbyqxmd.com/read/28663610/lignocaine-versus-ropivacaine-infiltration-for-postpartum-perineal-pain
#16
Jyoti P Deshpande, Girish Y Saundattikar
BACKGROUND: Millions of women worldwide undergo postpartum perineal repair under local infiltration. Inadequate postpartum pain management can negatively impact a mother's physical and psychological recovery. AIMS: To study and compare the analgesic effect and maternal satisfaction with lignocaine versus ropivacaine infiltration for postpartum perineal pain relief. MATERIALS AND METHODS: After clearance from the Institutional Ethics Committee, a double-blind prospective randomized study carried out on 100 parturients of aged 18-40 years who had spontaneous vaginal delivery, comparing 1% lignocaine and 0...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28658905/knowledge-and-attitude-of-parents-towards-avulsed-permanent-tooth-of-their-children-and-its-emergency-management-in-bhopal-city
#17
Ankur Jain, Parimala Kulkarni, Srikant Kumar, Manish Jain
INTRODUCTION: Dental avulsion is a commonly reported traumatic injury causing pain, aesthetic, functional, psychological and mental impairment. Since parents are in the immediate vicinity of children in such situations, their knowledge regarding the same is of great importance. AIM: The aim of present study was to assess the level of parental knowledge and their attitude towards dental avulsion and its emergency management. MATERIALS AND METHODS: A 10-stemmed questionnaire was prepared for this study which was modified form of questionnaire used by Raphael and Gregory...
May 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28641572/a-child-with-hypertension-and-ambiguous-genitalia-an-uncommon-variant-of-congenital-adrenal-hyperplasia-a-case-report
#18
Vivek Pant, Suman Baral, Bishal Shrestha, Arjun Tumbapo
BACKGROUND: Deficiency in 11β-hydroxylase as a cause of congenital adrenal hyperplasia is uncommon. It should be considered in the differential diagnosis of hypertension with virilization in any prepubescent child. CASE PRESENTATION: A 12-year-old Asian boy from eastern Nepal presented with pain in his abdomen and hypertension. He was raised as a male but had absent testicles since birth and had precocious puberty. Plasma testosterone, follicle-stimulating hormone, and luteinizing hormone were below baseline level...
June 23, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28635066/consensus-development-of-quality-indicators-for-end-of-life-care-for-elders-in-japan
#19
Harue Masaki, Nobuko Kawai, Keiko Matsumoto, Miyoko Kuwata, Sachiko Yoshioka, Midori Nishiyama, Ryoko Uchino, Hiroko Nagae, Megumi Teshima, Sayuri Sakai, Kazuko Endo
AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics...
June 2017: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/28631150/low-dose-subcutaneous-ketamine-for-postoperative-pain-management-in-rwanda-a-dose-finding-study
#20
Jon Tuchscherer, William P McKay, Theogene Twagirumugabe
PURPOSE: Good pain control is not a normal part of surgical care in sub-Saharan Africa due to lack of resources. The primary objective of this study was to determine an efficacious dose of subcutaneous ketamine for postoperative pain for use in a future randomized controlled trial. METHODS: Following research ethics board and local hospital approval for this research, we obtained informed consent from 31 patients undergoing major surgery for a random walk dose-finding study...
June 19, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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