综合疼痛护理干预对翼状胬肉术后疼痛的效果

目的 探讨综合疼痛护理干预对翼状胬肉术后疼痛的效果.方法 将132例翼状胬肉患者按就诊先后顺序分为两组,每组66例.两组患者均行翼状胬肉切除联合角膜缘干细胞移植术,术后进行常规治疗,对照组予以常规护理,观察组予以综合疼痛护理.观察3d.术后第1d、2d、3d,采用视觉模拟评分法评定疼痛程度;术后第3d,统计两组患者的满意度及心理状态.结果 术后两组视觉模拟评分法评分逐渐降低(P＜0.01),术后第1d及3d观察组显著低于对照组(P＜0.05或0.01).观察组满意率为94.4％,对照组为80.3％,观察组显著高于对照组(P＜0.05);观察组焦虑、恐怖率显著低于对照组(P＜0.05),轻松率显著高于对照组(P＜0.01).结论 综合疼痛护理干预能显著缓解翼状胬肉术患者术后疼痛程度,有利于提高护理满意度.     

疼痛护理干预在缓解骨科患者术后疼痛中的应用效果

目的：探讨疼痛护理干预在缓解骨科患者术后疼痛中的应用效果。方法：将2013年10月~2014年9月在我院行手术治疗的88例骨折患者采用随机数字表法分为对照组和观察组各44例,对照组采取常规护理,观察组采取疼痛护理,观察患者术后疼痛效果及对护理工作的满意情况。结果：观察组患者术后1、4、24 h 视觉模拟评分（VAS）与对照组比较差异有统计学意义（P ＜0.05）;患者术后镇痛剂使用率与对照组比较显著降低（ P ＜0.05）;对护理工作的满意度与对照组比较显著提高（ P ＜0.05）。结论：疼痛护理干预能改善骨科患者术后疼痛,提高患者对护理工作的满意度,临床应用价值较高。     

人性化护理干预在胸外科术后患者疼痛中的应用

目的探讨人性化护理干预在胸外科患者术后镇痛应用的效果。方法将106例患者按入院先后顺序随机分为观察组和对照组,各53例,对照组采用常规吗啡静脉止痛,观察组在常规基础上给予人性化护理干预,比较2组患者护理效果。结果观察组患者疼痛视觉模拟（VAS）评分明显低于对照组（P〈0.05）,护理质量满意度均优于对照组（P〈0.05）。结论人性化护理干预降低了患者VAS评分值,提高了患者对疼痛耐受力和护理质量满意度,为患者提供了优质满意服务。     

疼痛干预对鼻内镜术后患者疼痛控制满意度的影响

目的探讨疼痛干预对鼻内镜术后患者疼痛控制满意度的影响。方法选择60例双侧慢性鼻窦炎伴鼻息肉患者随机分为对照组30例和观察组30例。对照组采用常规护理措施,观察组在常规护理基础上实施疼痛干预措施,主要包括疼痛教育,疼痛评估,疼痛记录,疼痛护理等。结果观察组术后疼痛评分明显低于对照组,术后疼痛控制的满意度明显提高,两组比较差异有统计学意义(P0.01)。结论系统的疼痛干预可改善鼻内镜术后患者疼痛控制的满意度。     

疼痛管理护理模式对骨科患者术后疼痛及自我效能的影响

目的 探讨疼痛管理护理模式对骨科手术患者术后疼痛及自我效能的影响.方法 选取2015年2月～2016年10月住院治疗的骨科手术患者120例,根据随机数字表法分为观察组和对照组,各60例.对照组给予常规性护理,观察组在常规护理的基础上,予以疼痛管理护理.比较两组患者术后疼痛、舒适性及自护能力.结果 观察组术后第1、3、5、7天的视觉模拟评分（VAS）均显著低于同时期对照组,差异有统计学意义（均P〈0.05）.观察组干预后自我效能评分高于对照组,差异有统计学意义（P〈0.05）,卧床休息时间、平均住院时间短于对照组,差异均有统计学意义（均P〈0.05）,而患者术后舒适度评分、满意度评分高于对照组,差异均有统计学意义（均P〈0.05）.结论 疼痛管理护理可提高骨科手术患者术后自我效能,增强患者康复信心,减轻患者术后疼痛感,促进患者术后康复,提高患者术后满意度,值得临床运用.     

护理干预在减轻上肢骨折术后疼痛中的应用效果观察

选取100例上肢骨折患者,随机地分为对照组和观察组各50例。分别采用常规护理方法与个性化护理方法进行干预。比较两组患者术后疼痛的发生情况及护理满意度、护理后患者生活质量。结果根据视觉模拟评分法(VAS),对照组术后VAS评分为4.02±0.37分,显著小于观察组1.26±0.22分,差异显著(P<0.05);根据自行设计的护理满意度调查问卷,观察组患者护理满意度评分为92.28±4.90分,显著大于对照组80.11±3.87分,差异显著(P<0.05);观察组护理后生活质量评分显著高于对照组(P<0.05)。在常规护理基础上加强个性化护理干预,对有效缓解上肢骨折术后疼痛以及提高患者的护理满意度,应加以推广及使用。     

规范化疼痛干预对骨科术后疼痛的临床效果研究

目的探讨规范化疼痛干预对骨科术后患者疼痛的影响。方法将144例患者随机分为对照组和干预组,对照组实施常规骨科术后的护理,干预组采用规范化疼痛干预措施,即术前对患者进行疼痛健康教育,将疼痛强度记录在"疼痛护理记录单"中,针对不同的疼痛强度采取相应的措施。观察两组患者术后3d的数字疼痛强度量表(NRS)疼痛评分、睡眠满意度、疼痛缓解程度和休斯顿疼痛情况调查表。结果术后3d两组的平均疼痛强度和睡眠满意度差异均有显著意义(P<0.01);干预组患者经过规范化管理后,有效疼痛缓解率达91%,疼痛控制总体满意度和相关条目的满意度均值最低在8分。结论规范化疼痛干预能有效缓解骨科患者术后疼痛,提高睡眠满意度和疼痛护理的满意度,促进患者康复。     

时间护理在慢性神经病理性疼痛中的应用研究

目的探讨时间护理在慢性神经病理性疼痛中的应用效果。方法选取62例慢性神经病理性疼痛患者为研究对象,分为试验组和对照组各31例,对照组给予常规护理,试验组在此基础上遵循时间护理原则,结合认知情况、用药护理、音乐疗法及心理治疗等进行护理干预。对比两组患者住院第1天、第3天、第7天,进行疼痛视觉模拟评分、睡眠质量评分和满意度评分。结果住院第3天、第7天,试验组疼痛视觉模拟评分明显低于对照组(P0.01),试验组睡眠质量评分明显优于对照组(P0.01);住院第1天、第3天、第7天,试验组护理满意度评分均高于对照组(P0.01)。结论时间护理能显著缓解患者慢性神经病理性疼痛,提高睡眠质量和护理满意度。     

知信行模式干预对细胞因子诱导的杀伤细胞生物治疗中晚期肺癌患者疼痛的影响

目的探讨知信行模式干预对细胞因子诱导的杀伤细胞生物治疗中晚期肺癌患者疼痛的影响。方法将60例中晚期肺癌患者随机分为对照组和干预组各30例,对照组按照细胞因子诱导的杀伤细胞生物治疗进行常规护理,干预组在对照组基础上对患者疼痛实施知信行模式干预,比较两组患者干预前后视觉模拟疼痛评分和干预后疼痛控制满意度。结果干预后干预组视觉模拟疼痛评分低于对照组(P0.01),自我疼痛控制满意度高于对照组(P0.01)。结论知信行模式干预能有效减轻患者的疼痛程度,提高患者疼痛控制满意度。     

护理干预对减轻手外伤患者术后疼痛效果比较研究

目的:探讨护理干预对减轻手外伤患者术后疼痛的效果观察。方法:随机将128例手外伤患者分为干预组和对照组各64例。对照组给予常规手外伤术后护理,干预组在对照组基础上实施心理、行为、认知等护理干预。采用视觉模拟评分法评估疼痛,并做比较分析。结果:两组护理干预前后疼痛比较无显著性差异(P0.05),护理干预组术后疼痛低于对照组,差异显著(P0.01)。护理干预组止痛药物使用情况与对照组比较有显著性差异(P0.01)。结论:护理干预可减轻手外伤患者术后疼痛,加快患者术后康复,也有利于责任制整体护理质量的提高。     

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain.

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 weeks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.     

Adductor-related groin pain in the athlete

Background:

Owing to a multifactorial etiology, the differential diagnosis of groin pain in the athlete is often complex, with a diagnosis being clinically elusive in up to 30% of individuals. It has been suggested in the literature that the adductor musculature is a viable and prevalent source of groin pain. Thus, recognition of the elements related to effective management of these individuals is essential for the clinician.

Objectives:

To review the current literature related to prevalence, risk factors, clinical testing, conservative, and surgical interventions for adductor-related groin pain.

Major findings:

Adductor-related groin injuries may occur in isolation or combination. Athletes participating in multi-directional sports, with prior groin injury, weakness of adductors compared to abductors, and higher level of play are at greatest risk. Clinical testing using the adductor squeeze test at varying angles offers high specificity in the absence of imaging modalities. Evidence for preventative programs exists among soccer and ice hockey players. Interventions focusing on progressively improving adductor muscle performance and lower extremity impairments have been found effective, as have multi-modal interventions. Surgical interventions, recommended for those recalcitrant (>2 months) to conservative care appear effective, with adductor repair or tenotomy procedures being primarily described in case series designs.

Conclusion:

A paucity of research exists to determine the diagnostic utility of clinical tests as well as the efficacy of interventions. Clinicians should be aware of adductor-related groin pain as a clinical entity and recognize the potential merits and limitations of both preventive and adductor-focused interventions.     

Facial expression and pain assessment in the pediatric patient: the primal face of pain.

PURPOSE: This paper aims to explore the role of facial expression in pediatric pain assessment. A comparison of tools employing facial expression methodology is presented. The concept of the primal face of pain (PFP) is introduced. CONCLUSION: The PFP offers an explanation to the utility and deficiency of facial pain scales and facial expression in pain assessment. PRACTICE IMPLICATIONS. The complexities of pain measurement should preclude the clinical application of untested instruments. For reported tools, a careful evaluation of the psychometric properties and the clinical context must precede application. The concept of the PFP warns against the application of facial pain scales as proxy measures in their intended population. Reliance on facial expression to assess pain in the school-age child is imprecise.     

The influence of experimental pain intensity in the local and referred pain area on somatosensory perception in the area of referred pain

The aim of this study was to investigate the influence of experimental pain intensity in the local and referred pain area on somatosensory perception thresholds in the area of referred pain. Pain was induced by intramuscular electrical stimulation of the left infraspinatus muscle in 12 healthy individuals. The stimulation corresponded to the local pain threshold ("mild local pain"), the referred pain threshold ("mild referred pain"), and a pain intensity corresponding to 2 on a 10-point category scale in the referred pain area ("moderate referred pain"). Quantitative sensory testing was performed to assess perception thresholds in the referred pain area and the homologous contralateral area before and during stimulation. Perception thresholds to light touch (LTTs), pressure pain (PPTs), and to innocuous as well as noxious warmth and cold were assessed. During stimulation the LTTs increased in the referred pain area compared to baseline, uninfluenced by pain intensity. Perception thresholds to innocuous cold and warmth increased bilaterally during the stimulation, without relation to pain intensity. Heat pain thresholds were not affected. Compared to baseline, PPTs increased bilaterally during stimulation corresponding to "mild local pain" and "mild referred pain", respectively, and a further increase was seen during "moderate referred pain". The decreased sensitivity to innocuous cold, warmth, and pressure pain was bilateral, indicating activation of endogenous net inhibitory mechanisms interacting bilaterally. We found no influence of pain intensity on somatosensory thresholds restricted to the referred pain area and light touch was the only affected modality in the referred pain area only.     

Quantification of the pain terms hurt, ache and pain among nursing students

The aim of this study was to determine the quantitative meaning nursing students ascribe to the pain terms hurt (ont), ache (värk) and pain (smärta). In total, 549 nursing students filled in a questionnaire including questions about age, gender, and health care work experience. The students were also requested to rate response using a Visual Analogue Scale (VAS) rating for different statements about hurt, ache and pain. The results show that there were significant differences (p < 0.001) between rated intensity of the statements of hurt, ache and pain. There were, however, large variations in the students’ ratings of the pain terms; hurt ranged from 3 to 97 mm, ache from 7 to 97 mm and pain from 27 to 100 mm. There were no significant differences between male and female students regarding their ratings of hurt and ache when they were used to describe the worst self‐experienced pain. Female students rated their experience of pain significantly higher (p < 0.001) on the VAS compared with male students. There was no significant correlation between previous experience of health care work and rated intensity of hurt, ache and pain. In conclusion, this study shows that there exist significant differences between the pain terms hurt, ache and pain according to a rating on a VAS. However, the results also demonstrate that there are large individual variations in how the students quantify the fictitious patient statements of hurt, ache and pain.     

Effects of a pain education program on nurses' pain knowledge, attitudes and pain assessment practices in China

The purpose of this study was to develop, implement, and evaluate the impact of a Pain Education Program (PEP) for nurses in China. The effects of PEP were measured in a quasi-experimental design. A total of 196 nurses who met the inclusion criteria from five nursing units in two teaching hospitals participated in the study. Randomization took place at the hospital level to select experimental and control groups. The research intervention was the PEP, which had two components: (1) to educate nurses about pain management and (2) to implement daily pain assessment by using the Changhai Pain Scale. The duration of PEP was five weeks and intervention methods included focused education, group activity, and individual instruction. After the baseline data were collected, PEP was implemented in the experimental group. The control group (n = 90) received no intervention, and the experimental group (n = 106) received six hours of focused education training. During the fourth and fifth weeks of the training program, the researcher and the faculty instructed nurses in five nursing units on how to use the Changhai Pain Scale to assess patients’ pain levels and demonstrated how to document pain condition in the nursing records. Nurses in both groups filled out a set of questionnaires, which included a background information form and the Nurses’ Knowledge and Attitude Survey form, before the PEP (T1), at one month after the PEP (T2), and at three months after the PEP (T3). Nurses in the experimental group who received the PEP had a significant improvement in their pain knowledge and attitudes. Their scores on the Nurses’ Knowledge and Attitude Survey increased from 15.67 at T1 to 26.13 at T2 and 35.14 at T3. The scores of nurses in the control group were unchanged (from 15.20 at T1 to 14.29 at T2 and 14.93 at T3, P > 0.05). In addition, experimental group nurses had an improvement in pain assessment. The percentage of nurses who correctly used the Changhai Pain Scale to assess patients’ pain intensity increased significantly after the PEP, and the increased usage of the assessment tool between experimental and control groups also shows a statistical difference in trend (χ²=93.281, P < 0.001). The PEP has been demonstrated to be effective in improving nurses’ pain knowledge, attitudes, and assessment.     

Experimental muscle pain provokes long-lasting alterations of thermal sensitivity in the referred pain area.

This study explores thermal sensitivity and thermal nociception for signs of central sensitization in the area of referred muscle pain. Two groups of 24 healthy subjects (ss) each, and with mean ages of, respectively, 27 and 55 years, were first trained in quantitative sensory testing and pain rating. Then, in a second session, referred pain was evoked by injection of 6% hypertonic saline into the infraspinatus muscle. Cold and warm thresholds, synthetic heat threshold (SHT--evoked by an alternating pattern of adjacent cold and warmth), and thermal pain thresholds were measured within the referred pain area at a rate of 1/20 min for 60-120 min. All ss of both groups experienced referred pain mostly in the upper arm and of medium intensity. Pain lasted for approximately 12min with a shorter duration in the older group (p<0.02). The cold threshold increased significantly (p<0.001), and the warm threshold slightly, after the injection and remained high for the whole observation period (i.e. lower and higher temperatures were necessary to elicit cold and warmth, respectively). Threshold recovery was more delayed in the older age group. Of those 28 ss in whom cold pain threshold could be followed during the whole observation period, 18 ss showed an immediate threshold decrease of average 6 degrees C which outlasted the observation period. Four ss responded with a threshold increase. Heat pain thresholds were not affected in the referred pain area. Average synthetic heat threshold did not change; there were, however, distinct and lasting individual threshold shifts in either direction. Ss with lowered cold pain thresholds or evident threshold shifts for synthetic heat had also higher pain ratings. The results demonstrate that experimental muscle pain can induce long-lasting changes in thermal sensitivity and nociception. The unexpected cold threshold increase may tentatively be explained as an expression of long-term depression. The decrease of cold pain threshold or SHT in subgroups of ss may indicate central sensitization. However, the observed changes in this experiment do not provide an unambiguous indicator for central sensitization which seems to be rather individual and might depend on pain intensity and proneness to express central mechanisms of sensitization. Therefore in clinical pain states the individual pattern of sensory abnormalities has to be analysed and interpreted in addition to the pain parameters to assess central involvement.     

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1 week postoperatively, and 3, 6, and 12 months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12 months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week.