The scientific evidence for acute pain treatment

Macintyre, Pamela E.; Walker, Suellen M.

doi:10.1097/aco.0b013e32833c33ed

Cited by 15 publications

(14 citation statements)

References 43 publications

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“…There appears to be a trend toward more use of opioid due to increased attention paid to the treatment of acute, chronic, and cancer-related pain 17 18 . Pethidine, an opioid with predominantly κ-receptor agonist properties, is a phenylpiperidine derivative with a chemical structure similar to local anesthetics.…”

Section: Discussionmentioning

confidence: 99%

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial

Açmaz¹,

Bayraktar²,

Aksoy³

et al. 2015

Indian J Med Res

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Background & objectives:Patients frequently experience pain of moderate to severe degree during gynaecologic procedures. This prospective, randomized, placebo-controlled trial was aimed to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure.Methods:A total of 144 mutiparous women were randomly allocated to one of the six groups. The first group (control group) consisted of 22 participants and they did not receive any treatment. The second group had 26 participants receiving oral 25 mg dexketoprofen trometamol. The 23 participants of the third group received two puff lidocaine sprays on cervical mucosa. The forth group consisted of 25 participants receiving 100 mg pethidine. In the fifth group, the 23 participants received 1000 mg intravenous paracetamol and the sixth group consisted of 25 participants receiving diclofenac sodium.Results:Pethidine was the best choice for reducing pain score during curettage procedure (t2:intra-operative). All analgesic procedures were significantly effective in reducing pain during postoperative period (t3). Significant pain reduction was achieved for both intra- and postoperative period by using analgesics.Interpretation & conclusions: The results of our study showed that lidocaine puffs provided the best pain relief than the other analgesics used. Therefore, lidocaine may be considered as the first choice analgesic in fractional curettage (NCT ID: 01993589).

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Section: Discussionmentioning

confidence: 99%

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial

Açmaz¹,

Bayraktar²,

Aksoy³

et al. 2015

Indian J Med Res

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“…Pain is used as a quality indicator [ 3 – 5 ], and there are multiple guidelines for pain management [ 6 , 7 ]. Acute pain may have adverse physiological and psychological effects [ 8 , 9 ], but there is still inadequate treatment of pain in EDs [ 10 , 11 ]. Of the patients who arrive at the ED with a painful condition, more than 50 % indicate that the pain is moderate to severe [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of pain in a Norwegian Emergency Department

Dale

Bjørnsen

2015

Scand J Trauma Resusc Emerg Med

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BackgroundAlthough pain management is a fundamental aspect of care in emergency departments (EDs), inadequate treatment of pain is unfortunately common. There are multiple local protocols for pain assessment in the ED. This study evaluated whether the initial assessment and treatment of pain in the ED are in accordance with the in-hospital protocol of the ED at a Norwegian University Hospital.Materials and methodsProspective data on pain assessment and initial treatment in the ED were collected from nursing and physician documentation. The patients’ perceptions of subjective pain were recorded using a numerical rating scale (NRS) that ranged from 0 to 10.ResultsSeventy-seven percent of the 764 enrolled patients were evaluated for pain at arrival. Female patients had a higher probability of not being asked about pain, but there was no difference in the percentage of patients asked about pain with respect to age. Additionally, patients with low oxygen saturation and systolic blood pressure were less likely to be asked about pain. Of those with moderate and severe pain (58 %), only 14 % received pain relief.DiscussionAssessment and treatment of pain in the ED are inadequate and not in line with the local protocols. A focus on strategies to improve pain treatment in the ED is a necessary aspect of developing optimal acute patient care in Norway in the future.

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“…Clinicians usually coping with pain, therefore, face an almost impossible task in keeping up to date with integrating all of the current evidence applicable to their personal practice. Fortunately, assistance in recording and organizing knowledge is also increasingly available and comes in a number of different forms, including systematic reviews, clinical guidelines, evidence summaries, expert reviews and analgesic "league" tables [1]. While a large amount of evidence related to acute pain treatment is available, limitations may exist in terms of its quality as well as clinical significance, especially in the areas of neuraxial anesthesia and spinal opioid selection for postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

“…While a large amount of evidence related to acute pain treatment is available, limitations may exist in terms of its quality as well as clinical significance, especially in the areas of neuraxial anesthesia and spinal opioid selection for postoperative pain. The quality of evidence used in evidence summaries or guidelines is often graded, and in all cases evidence obtained from meta-analyses of randomized controlled trials (RCTs) is considered to be the 'highest' level [1]. However, it has been recently suggested that meta-analyses that evaluate studies about the treatment of postoperative pain can explore clinical heterogeneity associated with variable types of surgery to arrive at better implications for clinical practice [2].…”

Section: Introductionmentioning

confidence: 99%

Current Evidence for Spinal Opioid Selection in Postoperative Pain

Bujedo

2014

Korean J Pain

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BackgroundSpinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one.MethodsThe purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic.ResultsRecent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil.ConclusionsResults obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security.

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The scientific evidence for acute pain treatment

Cited by 15 publications

References 43 publications

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial

Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial

Assessment of pain in a Norwegian Emergency Department

Current Evidence for Spinal Opioid Selection in Postoperative Pain

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