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Open access

Andrada Ciucă and Adriana Băban

Abstract

The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. It has been proved that chronic pain is more strongly related to psychological factors than to treatment or illness related factors. Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.

Open access

Adam Srebrzyński, Rafał Ziółkowski, Katarzyna Płużańska, Krzysztof Kaczka, Krzysztof Kuzdak and Lech Pomorski

Analysis of the Analgesic Effect of Metamizole Sodium in Patients Operated on for Goitre

The aim of the study was to evaluate the analgesic effect of metamizole sodium administered intravenously during the day after surgery in patients operated on for nodular goitre - using the 11-point NAS scale (Numeric Analog Scale).

Material and methods. The study was comprised of 114 patients who had undergone surgery for nontoxic: 84 (73.7%) or toxic: 30 (26.3%) nodular goitre. The goitre size, according to the WHO classification ranged between III and I° (2). I° goitre was found in 31 (27%) patients, II° goitre - in 46 (40.4%) patients and III° goitre - in 37 (32.4%) patients. The age of patients ranged between 22 and 75 years (median 53, IQR 43-61). The goitre was localized in the neck in 103 (90.4%) patients and it partially reached the superior aperture of the thorax with its lower poles in 11 (9.6%) patients. Patients with coexisting diseases such as diabetes mellitus or peripheral neuropathy were excluded from the study. Patients were randomly assigned to 4 groups. Group I included 38 subjects in whom metamizole sodium was applied at a dose of 1 g intravenously every 6 hours for a day after surgery; the first dose was administered at the moment of surgical wound closure. Group II included 37 patients in whom metamizole sodium was applied according to the above-mentioned regimen and, additionally the surgical wound was injected with 10 ml of bupivacaine 0.25%. Group III consisted of 36 patients in whom 1 g of metamizole was first administered intravenously thirty minutes before surgery and the subsequent doses were systematically repeated at time intervals of 6 hours (preemptive analgesia), avoiding buvacaine wound infiltration. Group IV included 40 patients in whom ketoprophen was administered intravenously at a dose of 0.1 g every 6 hours for a day after the procedure. Surgical wounds were not injected with buvacaine in these patients, similarly as in groups III and I. In case of severe pain patients could additionally receive morphine 1 mg on-demand.

Results. Pain intensity was analyzed every 6 hours on NAS scale and pain scores ranged from 1 to 5.5. At all time points, the highest pain intensity scores were found in patients who received metamizole as monotherapy (group I) or ketoprofen (group IV), while the lowest were found in the groups where surgical wound was additionally injected with bupivacaine solution (group II) or additional metamizole dose was used before the procedure (group III). Patients from group II rated their pain intensity as slightly higher or similar to that in group III (statistically insiginficant). Similarly patients from group I had pain scores slightly higher or similar to scores reported in group IV (statistically insiginficant).

Conclusions. 1. The most intense pain was observed during the first 12 hours after thyroid surgery. 2. Administration of metamizole sodium according to the regimen that was applied in groups II and III provided sufficient analgesia. 3. Infiltration of the surgical wound with buvacaine or administration of an additional dose of metamizole sodium prior to the surgery (preemptive analgesia) results in postoperative pain relief and allows avoiding demand for opioid analgetics.

Open access

Iveta Strode and Inara Logina

Assessment of Postoperative Pain in Nursing

Introduction. Postoperative pain is a typical form of acute pain and is connected with extensive traumatization of tissue and operation wound traumatic edema, which in its turn, becomes a source of permanent nociceptive impulses. Insufficiently controlled postoperative pain is a factor of risk for the development of various pathologies, postoperative complications, as well as chronic pain.

Aim of the study. To study the usage of postoperative period pain intensity and quality assessment scales in the clinical practice of nursing, as well as availability of methods.

Materials and methods. Inquiry utilized quantitative research method - questionnaire. The questionnaire embraced 263 patients and 309 nurses, working in surgical profile. Survey was carried out in surgical profile wards in Riga and regional clinics of Latvia.

Results. Prevalent method, in our investigation of pain intensity evaluation, is patient's oral subjective and objective assessment of condition. Such method is mentioned by 87% (269/309) of respondents. A conventional and acknowledged method of pain objectivization - verbal descriptor pain intensity scale is applied by 22% (69/309) respondents, but visual analogue scale is utilized only by 5% (15/309) respondents. Assessment of postoperative pains as systematic and planed operation was marked by 41% (126/309) of surgical nurses.

Conclusions. Prevailing method in the clinical practice of pain assessment is patient's subjective and objective evaluation of condition. However, this method is insufficiently recorded and objectivizated. Therefore, it is an actual problem in surgical patient care and shows necessity for standards and improvement of postoperative pain management.

Open access

Wiwat Wajanavisit, Pongsthorn Chanplakorn, Noratep Kulachote, Puttavee Charoenwanthanang and Patarawan Woratanarat

Abstract

Background: Pain assessments help clinicians to evaluate their patients’ symptoms. However, patients’ satisfaction with pain management is difficult to interpret and may mislead the clinician into being satisfied with inadequate pain management.

Objective: We described and explored patients’ pain status, patients’ satisfaction with their pain management, the impact of pain on sleep habit and routine activities of daily living (ADLs), and the proportion of patients who had undertreatment of pain in the Orthopaedic Outpatient Department, Ramathibodi Hospital.

Methods: A prospective, cross-sectional survey study of pain characteristics and pain management of Orthopaedic outpatients aged over 18 years in the Orthopaedics Department, Ramathibodi Hospital using two parts of a verified questionnaire.

Results: In all, 863 patients were studied. Numbers of patients with acute or chronic pain were in similar proportions and mainly diagnosed as nociceptive pain (83.7%). Most of them suffered from moderate or severe pain (42.6% vs. 39.1%). Severity of symptoms was correlated with sleep disturbance and disturbance in ADLs. However, no correlation was revealed between satisfaction with pain management and the intensity of pain and there was also no correlation between satisfaction with pain management and sleep disturbance or disturbance in ADLs. Most commonly prescribed medications were nonsteroidal antiinflammatory drugs (NSAIDs) (58.8%). However, 93.4% of returning patients who suffered from severe pain were still treated with nonopioid analgesics.

Conclusion: Patients suffered from moderate to severe pain and had disturbances in their sleep habit and ADLs. Most of them were satisfied with previous pain management, which was usually with nonopioid analgesics including NSAIDs and muscle relaxants. This group included some patients who experienced a high intensity of pain. We recommend clinicians pay more attention to the pain intensity of individual patients and justify appropriate medication by using a step-up approach and multimodal analgesics

Open access

Renata Krzyszycha, Mariusz Goniewicz, Krzysztof Goniewicz, Witold Pawłowski and Piotr Wańkowicz

Abstract

Introduction. In Poland, among patients coming to hospital emergency departments (ED), one third require immediate surgical treatment. About one third are transferred to long-term intensive care. The remaining patients require a different type of care, e.g. consultation, healing wounds, observation in the emergency department. From there, they might either be referred to another hospital department or sent home after receiving outpatient help.

Aim. The aim of this study was to determine the prevalence of pain and stress in patients treated in the emergency department with particular emphasis on the factors that determine their level.

Material and methods. The study group consisted of 200 individuals treated in the emergency department of the Regional Hospital No. 2 in Rzeszów in 2013. The applied research method was a diagnostic survey that used a questionnaire as a research tool. The results were statistically analyzed using SPSS 20, whereas a statistically significant dependence was considered in those with level of significance p≤0.05.

Results. Most respondents reported pain and feelings of stress while staying in the ED. Women and the unemployed were significantly less likely to report pain. Factors like gender, age, education level, and the coexistence of chronic diseases significantly affected the degree of stress among patients in the ED.

Conclusion. Each patient treated at the emergency department should receive holistic care, so that the pain and stress of his injuries are reduced as soon as possible.

Open access

Irina Evansa, Edgars Vasilevskis, Michail Aron, Inara Logina and Indulis Vanags

Interventional Pain Management using Fluoroscopy and Ultrasound Imaging Techniques

Interventional injection therapies play a major role in the management of various pain conditions and are becoming an integral part of the multidisciplinary therapies required to improve and rehabilitate pain patients. Many of these procedures have historically been performed without imaging guidance. Imaging-guided techniques with fluoroscopy or ultrasound increase the precision of these procedures and help confirm needle placement. Imaging-guided techniques should lead to better results and reduced complication rates and they are now becoming more popular. These improvements are probably due in part also to better patient selection by experienced pain physicians.

Open access

Laura Mihaela Suciu, Manuela Cucerea, Marta Simon, Andreea Avasiloaiei, Olimpia Petrescu and Suciu Bogdan Andrei

Abstract

Introduction: Over the past 25 years, caregiver’s knowledge of pain in newborn infants has advanced from the beliefs that newborn infants do not feel pain, to the knowledge that preterm infants experience more pain compare to older children and adults. However, caregivers know that pain exists in this population and research has supported that pain continues to be untreated up to 65% of the time.

Aim of the study: The purpose of this study was to investigate the attitude and knowledge of health care professionals from the area of Neonatology in Romania regarding procedural pain management in newborn infants.

Material and methods: The sample consisted of 85 physicians and nurses (110 invited) working in five Neonatal Care Centres. Data were collected using a self-completion, 17 items questionnaire designed for this study.

Results: With a response rate of 77.27% which was similar in nurses and physicians, respondents in our study were aware about the pain experience during procedural interventions, recognized the items of pain scales assessment, and are not comfortable with the parental presence during painful procedures. Twenty-five percent of nurses versus 9% of physicians reported rushed care as an important barrier of adequate non-pharmacological pain management (95% IC, 0.319-0.003)

Conclusions: The use of pain protocols for an effective management of pain during neonatal period is required.

Open access

R. Trochimczuk, T. Kuźmierowski and P. Anchimiuk

Abstract

This paper defines the design assumptions for the construction of an original demonstration of a CPM device, based on which a solid virtual model will be created in a CAD software environment. The overall dimensions and other input parameters for the design were determined for the entire patient population according to an anatomical atlas of human measures. The medical and physiotherapeutic community were also consulted with respect to the proposed engineering solutions. The virtual model of the CPM device that will be created will be used for computer simulations of changes in motion parameters as a function of time, accounting for loads and static states. The results obtained from computer simulation will be used to confirm the correctness of the design adopted assumptions and of the accepted structure of the CPM mechanism, and potentially to introduce necessary corrections. They will also provide a basis for the development of a control strategy for the laboratory prototype and for the selection of the strategy of the patient's rehabilitation in the future. This paper will be supplemented with identification of directions of further research.