Access to Pain Management as a Human Right

Brennan, Frank; Lohman, Diederik; Gwyther, Liz

doi:10.2105/ajph.2018.304743

Cited by 96 publications

(60 citation statements)

References 16 publications

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“…Pain is 'an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage' (International Association for the Study of Pain, 2020). Access to pain management is considered a fundamental human right (Brennan et al, 2019), yet pre-hospital pain management in children is poor (Samuel et al, 2015). This is despite effective pain management being recently identified as a key quality outcome measure for emergency medical (ambulance) services (EMS) (Turner et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Whitley

Hemingway

Law

et al. 2020

J Child Health Care

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We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960

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Section: Introductionmentioning

confidence: 99%

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

Whitley

Hemingway

Law

et al. 2020

J Child Health Care

View full text Add to dashboard Cite

show abstract

“…This concept can be found in various reports and standards from the United Nations and other regional human rights organizations, and has direct implications on the practice of medicine and on the access to pain management resources. 1 Acute trauma pain has usually limited duration and has a rapid onset caused by a specific event. 2 Trauma patients frequently report pain: up to 70% in the prehospital setting 3,4 and 60-90% in the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

<p>Role of Inhaled Methoxyflurane in the Management of Acute Trauma Pain</p>

Fabbri

Ruggiano

Collado

et al. 2020

JPR

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Adequate treatment of trauma pain is an integral part of the management of trauma patients, not just for ethical reasons but also because undertreated pain can lead to increased morbidities and worse long-term outcomes. Trauma pain management presents challenges in the pre-hospital setting, particularly in adverse or hostile environments as well as in busy emergency departments (EDs). Inhaled methoxyflurane, administered at analgesic doses via a disposable inhaler, has recently become available in Europe for the emergency treatment of moderate to severe pain in conscious adult trauma patients. A growing body of evidence demonstrates that inhaled methoxyflurane is well tolerated and effective in providing a rapid onset of analgesia. In this paper, we discuss the rationale for methoxyflurane use in trauma pain management, data from clinical trials recently conducted in Europe, its efficacy and safety profile compared to current standard treatments, its place in therapy and organizational impact. We conclude that inhaled methoxyflurane represents an effective treatment option in the different settings where trauma patients require rapid and flexible pain resolution, with potential organizational advantages.

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“…Children are very frequent victims of trauma [2][3][4][5] making their presentation to the ED following a MSK injury very common [1]. Unfortunately, current pain management is widely recognized to be frequently insufficient, possibly because of uncertainty on which medications to prescribe, to the lack of clear and well established guidelines, to fear of adverse effects [8].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ibuprofen in musculoskeletal post-traumatic pain in children: A systematic review

Parri

Lazzeri

2020

PLoS ONE

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Musculoskeletal (MSK) injuries are one of the most frequent reason for pain-related evaluation in the emergency department (ED) in children. There is still no consensus as to what constitutes the best analgesic for MSK pain in children. However, ibuprofen is reported to be the most commonly prescribed analgesic and is considered the standard first-line treatment for MSK injury pain in children, even if it is argued that it provides inadequate relief for many patients. The purpose of this study was to review the most recent literature to assess the efficacy of ibuprofen for pain relief in MSK injuries in children evaluated in the ED. We performed a systematic review of randomized controlled trials on pharmacological interventions in children and adolescents under 19 years of age with MSK injuries according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the risk ratio for successful reduction in pain scores. Six studies met the inclusion criteria and provided data on 1028 children. A meta-analysis was not performed since studies were not comparable due to the different analgesic treatment used. No significant difference in term of main pain score reduction between all the analgesics used in the included studies was noted. Patients who received oral opioids had side effects more frequently when compared to children who received ibuprofen. The combination of effect on pain relief and tolerability would suggest ibuprofen as the initial drug of choice in providing relief from mild-to-moderate MSK pain in children in the ED. The results obtained in this review and current research suggest that there’s no straightforward statistically significant evidence of the optimal analgesic agent to be used. However, ibuprofen may be preferable as the initial drug of choice in providing relief from MSK pain due to the favorable combination of effectiveness and safety profile. In fact, despite the non-significant pain reduction as compared to children who received opioids, there are less side effect associated to ibuprofen within studies. The wide range of primary outcomes measured in respect of pain scores and timing of recorded measures warrants a future standardization of study designs.

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Access to Pain Management as a Human Right

Cited by 96 publications

References 16 publications

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

<p>Role of Inhaled Methoxyflurane in the Management of Acute Trauma Pain</p>

Efficacy of ibuprofen in musculoskeletal post-traumatic pain in children: A systematic review

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