赋能教育在癌痛患者中的应用

目的探讨赋能教育对癌痛患者疼痛控制的影响。方法将80例癌痛患者随机分为干预组与对照组各40例,对照组给予常规癌痛知识教育,干预组在此基础上结合赋能教育进行干预。观察两组癌痛患者在出院后4周服药依从性、癌性爆发痛发生率、癌痛控制障碍得分及疼痛应对策略得分情况。结果出院后4周干预组服药依从性及疼痛应对策略评分显著高于对照组,爆发痛发生率及癌痛控制障碍得分显著低于对照组(P 0. 05,P 0. 01)。结论对癌痛患者实施赋能教育能提高患者的服药依从性,减少癌性爆发痛发生率,减轻患者癌痛控制障碍,有利于患者采取积极的应对策略,从而更好地控制癌痛。     

居家癌痛管理APP软件的研制及应用评价

目的探讨护患APP在居家癌性疼痛患者中的应用效果。方法将80例出院癌痛患者随机分为对照组和观察组各40例,对照组实施常规出院后电话随访,观察组通过护患APP进行居家癌痛管理,出院3周后比较两组患者服药依从性、镇痛效果、满意度及疼痛评分。结果观察组患者服药依从性、镇痛效果、满意度显著高于对照组,疼痛评分显著低于对照组(P0.05,P0.01)。结论通过护患APP进行居家患者癌痛管理,可提高患者的遵医行为及镇痛满意度。     

癌痛规范化管理结合微信平台宣教对肿瘤患者镇痛的影响

目的探讨癌痛规范化管理结合微信平台宣教对晚期肿瘤患者镇痛和治疗依从性的影响。方法将肿瘤科收治的癌症并伴有癌痛的患者136例随机分为两组各68例。对照组采取癌痛规范化管理,观察组在进行癌痛规范化管理的同时结合微信平台宣教。出院3周比较两组患者癌痛程度、治疗依从性及满意度。结果观察组患者疼痛程度、服药依从性及满意度显著优于对照组(均P<0.01)。结论在癌痛规范化管理的同时配合微信平台宣教能够有效缓解癌痛患者的疼痛程度,调动患者治疗的依从性,提高其满意度。     

医护药一体化管理在癌痛患者中的应用

目的探讨医护药一体化管理在癌痛患者中的应用效果。方法按时间段将91例恶性肿瘤疼痛患者分为对照组44例、观察者47例;对照组行常规癌痛管理,观察组成立医护药一体化癌痛管理小组实施协同管理。结果观察组镇痛药服药依从性显著高于对照组,疼痛评分显著低于对照组(P 0. 05,P 0. 01)。结论对癌痛患者实施医护药一体化管理,可有效提高患者镇痛药服药依从性,从而有效缓解疼痛。     

难治性癌痛患者的多专科协作精准护理

目的探讨基于多专科协作的精准护理模式在难治性癌痛患者中的应用效果。方法将镇痛科收治的208例难治性癌痛患者按住院时间分为对照组与观察组各104例,对照组给予常规癌痛护理,观察组创建多专科护理团队实施专科协作的精准护理,出院1个月采用简明疼痛量表、癌痛自我效能感量表、癌症患者生活质量量表进行调查。结果出院后1个月,观察组患者疼痛评分显著低于对照组,癌痛自我效能感及生活质量得分显著优于对照组(均P0.01)。结论基于多学科协作的精准护理模式能有效改善难治性癌痛患者的疼痛状况,提高其自我效能感及其生活质量。     

专科护士主导的护理干预对高龄髋部骨折患者的影响

目的 提高高龄髋部骨折患者围手术期护理效果。 方法 按照入院时间，将2018年1月至2019年12月收治的50例高龄髋部骨折患者作为对照组，2020年1月至2021年12月收治的47例高龄患者作为观察组。对照组按责任制整体护理模式实施围手术期护理常规；观察组实施专科护士主导的多学科合作模式的全程护理干预，包括综合评估患者、集束化预防护理、结合康复日志的康复锻炼、出院准备及随访。比较两组疼痛干预效果、功能锻炼依从性及并发症发生率。 结果 观察组疼痛干预有效率显著高于对照组，围手术期并发症发生率显著低于对照组，功能锻炼依从性显著高于对照组（均P＜0.05）。 结论 高龄髋部骨折患者实施专科护士主导的多学科合作模式的护理干预，有利于提高护理质量，改善患者临床结局。     

脊柱转移癌患者压疮防护临床研究

目的提高脊柱转移癌患者翻身依从性,降低压疮发生率。方法将58例脊柱转移癌患者按入院时间段分为对照组28例和观察组30例;对照组在常规镇痛基础上由3人共同实施轴线翻身;观察组采用自制轴线翻身垫及与之相匹配的翻身流程翻身,强化疼痛干预及护理措施的落实。结果患者翻身后即刻疼痛评分、翻身依从性、压疮发生率与对照组比较,差异有统计学意义(P0.05,P0.01);每次翻身操作由3~4人减少到1~2人。结论轴线翻身垫的应用及相应措施的实施,可有效提高脊柱转移癌患者压疮护理效果,同时节省护理人力资源。     

放射性口腔黏膜炎患者医护一体化疼痛护理干预

目的探讨基于医护一体化的疼痛护理干预对放射性口腔黏膜炎患者生存质量及营养状态的影响。方法将100例鼻咽癌放疗患者分为观察组和对照组各50例,对照组实施常规护理,观察组给予医护一体化管理模式下的疼痛护理干预。比较两组患者放射性口腔黏膜炎及放射性口腔疼痛发生程度、营养状况及生存质量评分。结果观察组患者放射性口腔黏膜炎、放射性口腔疼痛发生程度显著轻于对照组(均P0.01),营养风险评分显著低于对照组,生存质量评分显著优于对照组(均P0.01)。结论医护一体化疼痛管理模式可降低鼻咽癌放疗患者放射性口腔黏膜炎及放射性口腔疼痛的发生程度,改善营养状况及生活质量。     

基于认知负荷理论的维持性血液透析患者限制液体摄入健康教育

目的探讨基于认知负荷理论的维持性血液透析患者限制液体摄入健康教育策略的应用效果。方法将100例维持性血液透析依从性差的患者按随机数字表法分为对照组和观察组各50例,对照组给予维持性血液透析常规护理及健康教育,观察组采用认知负荷理论构建并实施患者限制液体摄入健康教育策略,观察两组干预前和干预6个月液体摄入依从性及血液透析并发症发生率。结果干预后两组液体摄入依从性总分均较干预前显著提高,且观察组依从性得分显著高于对照组(P0.05,P0.01);观察组高血压、低血压、心律失常、肌肉痉挛发生率显著低于对照组(均P0.01)。结论实施基于认知负荷理论的健康教育策略,可提高维持性血液透析患者限制液体摄入的依从性,降低并发症发生率。     

专科护理门诊个案管理对永久性起搏器植入患者的影响

目的 探讨专科护理门诊个案管理对永久性起搏器植入患者复诊及服药依从的影响。方法 将首次植入永久起搏器患者134例采用随机数字表法分为对照组和干预组各67例。对照组给予微信或电话方式进行常规随访,干预组实施专科护理门诊个案管理,即通过线上及专科护理门诊方式对患者进行随访与个性化健康教育。比较两组出院后1、3、6个月的复诊率、服药依从性。结果 出院后1、3、6个月干预组复诊率、服药依从性显著高于对照组(P<0.05,P<0.01)。结论 对永久性起搏器植入患者实施专科护理门诊个案管理,促进患者出院后专业化护理的延续和全程管理,可以显著提高其术后复诊率、服药依从性。     

Discogenic pain in acute nonspecific low-back pain

Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral disc sites with an obvious enhanced region in the posterior annulus of the disc on enhanced T1-weghted MR images was selected for intradiscal injection. When no enhaced region was detected, the most severely degenerated disc on T2-weighted MR images was selected. Acute nonspecific low-back pain with an improvement rate of 70% or higher 5min after injection was judged to be discogenic. The clinical characteristics and pathogenesis of discogenic acute nonspecific low-back pain were investigated. Forty of the 55 patients (73%) had discogenic acute nonspecific low-back pain. As for the characteristics of patients, the mean age was 37 years, and onset occurred upon casual daily movements in 18 patients (45%). Nineteen patients (48%) had bilateral low-back pain, and 29 patients (73%) had no tenderness in the paravertebral muscles. On plain X-ray radiograms, degeneration of the disc was normal or mild in 36 patients(91%). On the discograms, a radial tear extending to the posterior annulus was noted in all patients, but epidural leakage was seen only in six patients (15%). The degree of disc degeneration on T2-weighted MR images (Gibsons classification) was grade 3 in 30 patients (75%). Gadolinium-DTPA enhanced T1-weighted MR images showed an obvious enhanced region in the posterior annulus of the intervertebral disc in 19 patients (48%). As for the clinical characteristics of discogenic acute nonspecific low-back pain, the relatively young adult patients had no tenderness in the paravertebral muscles, and showed moderately degererated intervertebral discs. The pathogenesis of discogenic acute nonspecific low-back pain is mostly considered to be a re-rupture in an asymptomatic ruputured region in the posterior annulus, repaired by granulation tissue, in a moderately degenerated intervertebral disc with a radial tear.     

Paediatric chronic pain

Many children and adolescents experience chronic pain at some point in their childhood. While the majority may be successfully supported by their local services, some may develop persistent pain-related functional disability that should prompt referral to a multidisciplinary paediatric pain service for assessment. These teams work with the family to provide a framework for promoting rehabilitation and restoration of function based on the biopsychosocial model. Mental health difficulties including psychological trauma are often a significant factor. Individualized therapeutic work is core to the pain management pathway. Medications and therapeutic injections are used less frequently in children compared to adult practice but may have a role in facilitating rehabilitation as part of a multidisciplinary approach.     

From pain research to pain treatment: the role of human experimental pain models

There is no objective measure of a complete pain perception; we can, however, measure different aspects of nociceptive processing and pain perception. Earlier, experimental pain models often only involved induction of cutaneous pain using a single stimulus modality. Recently new experimental models have been developed eliciting various modalities of deep and visceral pain which more closely resemble clinical pain conditions. It is imperative to use multi-modal and multi-structure pain induction and assessment techniques, because a simple model cannot describe the very complex and multi-factorial aspects of clinical pain. Furthermore, it is important to assess pain under normal and pathophysiological conditions.The importance of peripheral and central hyperexcitability for acute and chronic pain has been demonstrated in animals and, to some extent, in humans. However, in spite of our immense knowledge, we still do not know how to prevent and treat this hyperexcitability efficiently. Our understanding of nociceptive mechanisms involved in acute and chronic pain and the effects of anaesthetic drugs or combinations of drugs on these mechanisms in humans may also be expanded using human experimental models. This mechanism-based approach may help us to develop and test therapeutic regimes in patients with acute and chronic pain.     

Interventional pain management for phantom limb pain: An algorithmic approach

Phantom limb pain is a type of chronic pain existing in different organs, not just limbs. The incidence is very high in the postamputation period and treatment can be a challenge. The pharmaceutical treatment strategies in addition to psychological rehabilitative strategies and interventional management play a successful role in the management of these patients. For this article, we conducted a review of literature about pain management for phantom limb pain to identify the treatment modalities, which involved interventional pain management, and an algorithmic approach is proposed.     

Management of acute pain

Acute pain is a common feature in the presentation of surgical and traumatic pathology and in postoperative patients. In pathological presentations acute pain may have a protective role serving as a warning sign, with muscle spasm helping to limit movement and prevent further injury. Acute postoperative pain can hinder recovery due to limited mobility and may lead to a range of complications, increasing patient morbidity and mortality. Timely and effective management of acute pain is therefore imperative. An acute pain service (APS) is able to assist in the management of complex patients and those with specific invasive analgesic interventions. However, the immediate prescribing is the responsibility of the admitting surgical doctor and therefore this article aims to give an overview of the considerations needed to ensure safe and effective management of acute pain.     

Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

BACKGROUND: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. METHODS: Patients were assessed at referral (T(0)) and after a treatment period of 3 months (T(3)) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T(0) to T(3) was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. RESULTS: Thirty-three patients were assessed at T(0) and 27 at T(3). The prevalence of BTP declined significantly from T(0) (90%) to T(3) (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T(0) to T(3.) The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). CONCLUSION: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression.     

Persistent post-surgical pain and neuropathic pain after total knee replacement

AIM: To study the prevalence of persistent post-surgical pain (PPSP) and neuropathic pain (NP) after total knee replacement (TKR).METHODS: MEDLINE and Embase databases were searched for articles published until December 2014 in English language. Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis, and measured pain with pain specific instruments. Studies that referred to pain caused by septic reasons and implant malalignment were excluded. Both prospective and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review.RESULTS: The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP. The reported prevalence of PPSP and NP seems to be relatively high, but it varies among different studies. There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement. The prevalence of PPSP is ranging at 6 mo from 16% to 39% and at 12 mo from 13.1% to 23% and even 38% of the patients. The prevalence of NP at 6 mo post-operatively is ranging from 5.2% to 13%. Pre-operative factors related to the development of PPSP also differ, including emotional functioning, such as depression and pain catastrophizing, number of comorbidities, pain problems elsewhere and operations in knees with early grade of osteoarthritis.CONCLUSION: No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies.     

Improvement of burn pain management through routine pain monitoring and pain management protocol

Introduction

Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system.

Methods

From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n = 58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n = 49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS).

Results

The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8 ± 2.0 versus 3.9 ± 1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8 ± 2.8 versus 3.7 ± 2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance.

Conclusion

Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches.