Acute Pain最新文献

Background

The aim of the present study was to determine the effectiveness of the coping strategies – distraction and redefining – on pain experience in individuals with internal vs. external locus of control.

Method

The participants were exposed to pain induced by cold pressor procedure. Pain tolerance, pain intensity, and objective and subjective duration of pain were measured in three different situations. In the control situation, the participants did not use any cognitive pain coping strategy. In two other situations, they used distraction and redefining strategies, respectively.

Results

Internally- and externally-oriented participants did not differ in pain tolerance, pain intensity ratings, and subjective duration of painful stimulation in any of the three situations. The use of cognitive pain coping strategies increased pain tolerance in both groups in comparison with the control situation. In both situations, the participants underestimated the duration of pain tolerance. There was no difference between the effectiveness of distraction and redefining strategies on pain tolerance and pain intensity ratings.

Conclusion

Cognitive pain coping strategies increase the duration of pain tolerance irrespective of the individual's locus of control, but have no effect on pain intensity rating.

The choice of an oral analgesic is an important determinant in achieving effective pain relief. Properties of an ‘ideal analgesic’ required for the management of acute pain are discussed and current evidence for the suitability of available analgesics – acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen), opioids and combination therapy – is reviewed. The hypothesis that an ‘ideal analgesic’ for acute pain should have a rapid onset of action, act over an extended period of time, reduce awareness of pain quickly and minimise interruption by pain, be well tolerated and produce analgesia over a wide range of pain types in different patient populations, is proposed herein. Currently available analgesics may fulfil only some of these characteristics and, because individual patient response also varies, the challenge is to define what constitutes an acceptable analgesic for a specific patient or pain type.

Various tools for measurement of each of these characteristics exist, but there is currently no single measure to determine the ‘ideal analgesic’ for a specific patient with a specific pain type that takes into account all the characteristics of an ‘ideal analgesic’ and provides an overall measure to quantify the quality of relief produced.

Background

Issues associated with the analgesic failure are major contributors to diminished postoperative health quality. The aim of this survey was to investigate the risk factors associated with anaesthesiologists for inadequate postoperative pain management, i.e. ≥3 cm in a 10 cm gauge of Visual Analog Scale.

Methods

A total of 1162 confidential questionnaires were sent by mail to anaesthesiologists in clinical hospitals. Information was queried on the incidence of inadequate postoperative pain management with different length of experience in anaesthesia, reasons for such incidence and possible rescue treatments after the occurrence of the incidence, and knowledge in terms of analgesia protocols. Education background and working settings were requested as the contributing factors.

Results

In 813 returned questionnaires, 798 were completed and the data were valid for analysis (68.7% valid response rate). Approximately 43% reported encountered at least one or more incidents of inadequate postoperative analgesia. All positive answers indicated inadequate postoperative analgesia was related to types of surgery. A multiple logistic regression (r² = 0.74, P < 0.0001) analysis revealed that age, length of anaesthesia experience, education background and work environment are four risk factors in contributing to the incidence. Patient-controlled analgesia is the first choice for postoperative pain therapy, and opioids are preferred as the rescue drugs for inadequate postoperative analgesia.

Conclusions

Inadequate postoperative analgesia occurs widely. Age, length of anaesthesia experience, education background and the working environment of anaesthesiologists are risk factors for inadequate postoperative pain control.