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Journal of the American Association For... Jan 2013Animals experiencing major invasive surgery during biomedical research must receive appropriate and sufficient analgesia. The concept of pain management in veterinary... (Review)
Review
Animals experiencing major invasive surgery during biomedical research must receive appropriate and sufficient analgesia. The concept of pain management in veterinary medicine has evolved over the past several decades, and a multimodal, preemptive approach to postoperative analgesia is the current standard of care. Here, the pathophysiology of pain and a multimodal approach to analgesia for neurosurgical procedures is discussed, with emphasis on those involving nonhuman primates.
Topics: Analgesia; Analgesics; Animal Welfare; Animals; Neurosurgical Procedures; Pain Management; Pain, Postoperative; Primates
PubMed: 23562027
DOI: No ID Found -
International Review of Neurobiology 2018Placebo analgesia is a robust experimental and clinical phenomenon. While our understanding of the mechanisms of placebo analgesia has developed rapidly, some central...
Placebo analgesia is a robust experimental and clinical phenomenon. While our understanding of the mechanisms of placebo analgesia has developed rapidly, some central questions remain unanswered. Among the important questions is how placebo analgesia interacts with active analgesic effects. It is an assumption underlying double-blind randomized placebo-controlled trials (RCTs) that the true effect of a treatment can be determined by examining the effect of the active treatment arm and subtracting the response in the placebo group ("the assumption of additivity"). However, despite the importance of this assumption for the interpretation of RCTs, it has rarely been formally examined. This article reviews the assumption of additivity in placebo analgesia by examining studies employing factorial designs manipulating both the receipt of an active analgesic and instructions about the treatment being delivered. In reviewing the literature, we identified seven studies that allowed a test of additivity. Of these, four found evidence against additivity, while the remaining three studies found results consistent with additivity. While the limited available data are somewhat mixed, the evidence suggests that at least under some conditions the assumption of additivity does not hold in placebo analgesia. The concordance between mechanisms of the active analgesic and placebo analgesia may influence whether additivity occurs or not. However, more research using factorial designs is needed to disentangle the relationship between placebo analgesia and the active effect of analgesic treatments.
Topics: Analgesia; Biomedical Research; Humans; Pain; Placebo Effect
PubMed: 30146056
DOI: 10.1016/bs.irn.2018.07.021 -
The Journal of Pain Mar 2011The prevalence of pain and pain undertreatment in older persons, along with the many potential detrimental consequences of undertreated pain, pose a substantial burden... (Review)
Review
The prevalence of pain and pain undertreatment in older persons, along with the many potential detrimental consequences of undertreated pain, pose a substantial burden to the individual, their family, and society. An accurate pain assessment is the foundation for treating pain; yet, thorough pain assessments and regular reassessments are too often neglected. Older adults typically present with multiple pain etiologies, making it all the more imperative that a comprehensive assessment is conducted. Comprehensive assessments should include a detailed investigation of a patient's pain and medical history, a physical examination, and diagnostic testing, if needed. Both the impact of pain and its severity should be established by questioning about the presence of pain and using pain assessment instruments. Tools for pain assessment should be tested in older adult populations to establish reliability, validity, and sensitivity to changes from treatment. Self-report is the gold standard for assessing pain; however, in many clinical circumstances with older adults, the patient's verbal report is unobtainable. Following an unsuccessful attempt at self-report from a nonverbal older adult, the potential causes of pain should be explored. Direct observation can then be used to identify behaviors suggestive of pain, and the patient's response to an analgesic trial can be observed. A pain behavior tool can also provide useful information suggesting the presence of pain.
Topics: Aged; Aging; Analgesia; Geriatric Assessment; Humans; Pain; Pain Measurement
PubMed: 21396599
DOI: 10.1016/j.jpain.2010.11.011 -
Anaesthesia Apr 1998Infusion pumps incorporating 'Diprifusor' for the administration of propofol by target controlled infusion are now commercially available and are becoming more widely... (Review)
Review
Infusion pumps incorporating 'Diprifusor' for the administration of propofol by target controlled infusion are now commercially available and are becoming more widely used. This paper considers possible future applications of target controlled infusion and summarises results obtained using prototype systems as a component of other control techniques and with other drugs. These include studies with patient-controlled systems for the administration of analgesia or sedation and a closed loop control system for the administration of propofol. Among currently available analgesic drugs, alfentanil and remifentanil are considered to be the most suitable for administration by target controlled infusion, but commercial systems for these agents are not yet available.
Topics: Analgesia; Anesthesia, Intravenous; Conscious Sedation; Decision Making, Computer-Assisted; Humans; Infusion Pumps
PubMed: 9640118
DOI: 10.1111/j.1365-2044.1998.53s110.x -
BMC Anesthesiology Nov 2022Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature.
METHODS
Four hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded.
RESULTS
Maternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group.
CONCLUSION
Our findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia.
TRIAL REGISTRATION
ChiCTR1900026606 . Registered on 16/10/2019.
Topics: Infant, Newborn; Female; Humans; Analgesia, Epidural; Analgesia, Obstetrical; Temperature; Fever; Anesthetics, Local; Anesthesia, Epidural
PubMed: 36380286
DOI: 10.1186/s12871-022-01898-w -
CMAJ : Canadian Medical Association... Apr 2007
Topics: Acupuncture, Ear; Analgesia; Health Knowledge, Attitudes, Practice; History, 20th Century; Humans
PubMed: 17452668
DOI: 10.1503/cmaj.1070008 -
The Canadian Veterinary Journal = La... Mar 2000
Topics: Analgesia; Anesthesia; Animals; Veterinary Medicine
PubMed: 10738603
DOI: No ID Found -
Journal of Pain and Symptom Management May 2005Patient-controlled analgesia (PCA) has become the gold standard for acute pain management since it was first introduced 20 years ago, and its merits have been discussed... (Comparative Study)
Comparative Study Review
Patient-controlled analgesia (PCA) has become the gold standard for acute pain management since it was first introduced 20 years ago, and its merits have been discussed in quite a large number of publications. This review summarizes the more recent developments, such as new application devices and strategies, including intranasal, spinal, and regional PCA; patient-controlled sedation; experience with children and elderly people; and some data from chronic pain situations. Analyzing PCA literature from 2001 onwards confirms the author's long belief that the PCA principle ("WYNIWYG": what you need is what you get) was the most important aspect of a patient-controlled strategy, more or less independent of the type of drug or machine. Discovering this principle has changed the understanding of pain and suffering.
Topics: Analgesia, Patient-Controlled; Cost-Benefit Analysis; Humans; Neoplasms; Pain; Treatment Outcome
PubMed: 15907649
DOI: 10.1016/j.jpainsymman.2005.01.005 -
BMJ Open Apr 2022To explore allophone immigrant women's knowledge and perceptions of epidural analgesia for labour pain, in order to identify their information needs prior to the...
OBJECTIVES
To explore allophone immigrant women's knowledge and perceptions of epidural analgesia for labour pain, in order to identify their information needs prior to the procedure.
DESIGN
We conducted focus groups interviews with allophone women from five different linguistic immigrant communities, with the aid of professional interpreters. Thematic analysis of focus group transcripts was carried out by all authors.
SETTING
Women were recruited at two non-profit associations offering French language and cultural integration training to non-French speaking immigrant women in Geneva.
PARTICIPANTS
Forty women from 10 countries who spoke either Albanian, Arabic, Farsi/Dari, Tamil or Tigrigna took part in the five focus groups. Four participants were nulliparous, but all others had previous experience of labour and delivery, often in European countries. A single focus group was conducted for each of the five language groups.
RESULTS
We identified five main themes: (1) Women's partial knowledge of epidural analgesia procedures; (2) Strong fears of short-term and long-term negative consequences of epidural analgesia during childbirth; (3) Reliance on multiple sources of information regarding epidural analgesia for childbirth; (4) Presentation of salient narratives of labour pain to justify their attitudes toward epidural analgesia; and (5) Complex community positioning of pro-epidural women.
CONCLUSIONS
Women in our study had partial knowledge of epidural analgesia for labour pain and held perceptions of a high risk-to-benefits ratio for this procedure. Diverse and sometimes conflicting information about epidural analgesia can interfere with women's decisions regarding this treatment option for labour pain. Our study suggests that women need comprehensive but also tailored information in their own language to support their decision-making regarding epidural labour analgesia.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Emigrants and Immigrants; Female; Humans; India; Labor Pain; Labor, Obstetric; Pregnancy
PubMed: 35428638
DOI: 10.1136/bmjopen-2021-057125 -
British Journal of Anaesthesia Dec 2010Neuraxial analgesic techniques are the gold standards for pain relief during labour and delivery. Despite the increased use and known benefits of neuraxial labour...
Neuraxial analgesic techniques are the gold standards for pain relief during labour and delivery. Despite the increased use and known benefits of neuraxial labour analgesia, there has been significant controversy regarding the impact of neuraxial analgesia on labour outcomes. Review of the evidence suggests that effective neuraxial labour analgesia does not increase the rate of Caesarean delivery, even when administered early in the course of labour; however, its use is associated with a prolonged second stage of labour. Effective second-stage analgesia might also be associated with an increased rate of instrumental vaginal delivery.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Cesarean Section; Delivery, Obstetric; Extraction, Obstetrical; Female; Humans; Labor, Obstetric; Pregnancy; Time Factors
PubMed: 21148655
DOI: 10.1093/bja/aeq311