Pain Management Nursing最新文献

Background: Patients recovering from bariatric surgery report the highest average pain during hospital admission, compared to patients recovering from other abdominal surgeries. Studies have shown many benefits from early mobilization after surgery, however, the effect of early mobilization after bariatric surgery on pain and physical function is unknown. This study aims to investigate the effects of an early initiated mobilization at the post anesthesia care unit and continued for the first 4 postoperative weeks.

Methods/design: This randomized controlled trial with a nested interview study requires 112 patients randomized 1:1 to intervention or control group. The mobilization intervention is divided in two: during hospitalization and after hospitalization at the patients' home or local healthcare center. The primary outcome for the first part is mean abdominal pain (numerical rating scale) during the first 24 postoperative hours. For the second part, physical function (six-minute walk test) is the primary outcome.

Secondary outcomes: opioid consumption, postoperative nausea and vomiting, physical activity, quantitative sensory testing, readmission rates, workability and sleep quality. Twelve patients will be interviewed twice to investigate their experiences.

Discussion: The study strives to enhance rehabilitation after obesity surgery, i.e., prevent complications caused by pain and physical inactivity. Furthermore, it strives to promote continuity in care between the hospital sector and the municipality.

Trial registration: ClinicalTrials.gov Identifier: NCT06222151.

Background: Effective pain management is essential for individualized nursing care, yet studies report nursing students often have insufficient knowledge in this area. Empathic tendency may act as a key factor, influencing how knowledge about pain management translates into individualized care practices.

Purpose: The aim of this study was to examine the relationship between nursing students' knowledge and attitudes toward pain management and their perceptions of individualized care and to evaluate the mediating role of empathic tendency in this relationship.

Design: This study is a cross-sectional descriptive study.

Methods: This descriptive and correlational cross-sectional study was conducted with 267 nursing students who were studying at a state university in the 2024-2025 academic year and had clinical practice experience. Data were collected using the Student Information Form, Knowledge and Attitudes Survey Regarding Pain, Individualized Care Scale-Nurse, and Empathic Tendency Scale. Pearson correlation, linear regression, and PROCESS Macro (Model 4) were used in statistical analysis.

Results: A significant and positive correlation was found between the level of knowledge about pain and perception of individualized care (r = 0.403, p < .001). Empathic tendency significantly predicted the perception of individualized care (β = 0.346, p < .001) and partially mediated the relationship between knowledge and attitudes about pain and individualized care (Indirect β = 0.168, CI [0.080-0.275]).

Conclusion: Both knowledge about pain and empathic tendency increase nursing students' competence to provide individualized care. Pain management should be integrated with empathy development in educational programs.

Objective: This study aimed to evaluate the efficacy and safety of intravenous (IV) lidocaine as an alternative analgesic approach in the management of postoperative pain.

Methods: A PubMed search was conducted using keywords related to intravenous lidocaine and opioid use in postoperative pain management. We focused on randomized controlled trials and clinical trials published in the past 10 years. Two independent reviewers screened titles, abstracts, and full texts, providing justifications for any exclusions. Of the 44 articles initially identified, 20 met the inclusion criteria and were included in the final analysis and summary tables.

Discussion: The review revealed conflicting evidence regarding the efficacy of IV lidocaine with some studies reporting significant reductions in opioid consumption, improved pain relief, and enhanced recovery parameters, while others questioned its benefit in reducing opioid consumption. Variability in lidocaine dosing regimens, surgical settings, and patient populations may contribute to the discrepancies observed in the literature. Challenges and limitations in the interpretation of study findings, including methodological issues and potential biases, were discussed.

Conclusion: IV lidocaine for postoperative pain management shows mixed and inconclusive results, with both potential benefits and limitations, indicating that no definitive conclusion can be drawn and further research is needed to establish its efficacy.

Purpose: Chronic pain is common for older adults living with dementia in nursing homes. The purpose of this study was to describe the current nonpharmacologic approaches used to treat pain among nursing home residents living with dementia and test the factors associated with the use of nonpharmacologic approaches.

Design and methods: This was a secondary data analysis using baseline data from the first six communities participating in the study, "Testing the Implementation of the Pain Management Clinical Practice Guideline Using the Evidence Integration Triangle." A total of 136 residents were included. Data was obtained from the electronic health record and observations using the Pain in Advanced Dementia Scale.

Results: The mean age of the participants was 80.3 years (standard deviation = 9.8), the majority were female (68%), and approximately half were white (52%), with 4 (3%) being Hispanic. Overall, 28 residents (21%) had pain, and the majority received at least one nonpharmacological intervention (n = 103, 76%). There was a significant association between oral pain medications given (Beta = .24, t = 2.9, p < .001), having diabetes (Beta = 2.1, t = 2.5, p = .01), and cognitive status (Beta = -.17, t = -2.0, p = .05) with the total number of nonpharmacologic interventions received. Age, sex, race, ethnicity, or musculoskeletal or neurologic diagnoses were not associated with the use of nonpharmacologic approaches.

Conclusions: Nonpharmacologic interventions are commonly used in this population, and there was no evidence of disparities in use based on age, sex, race, or ethnicity. As per pain guidelines, nonpharmacologic interventions should be the first treatment approach, particularly for those with cognitive impairment.

Purpose: Pain management is a global health problem. A large number of patients still suffer from pain despite the increasing development of science and technology, and nurses are frequently exposed to patients' pain and play a crucial role in pain management. This study aimed to explore nurses' challenges in managing pain in hospitalized patients.

Methods: This qualitative study was conducted in Arak (one of the central cities of Iran). Researchers used a purposive sampling technique, interviewing 14 clinical nurses, and continued until data saturation. Data were collected through semi-structured face-to-face interviews. The qualitative content analysis was used to analyze data.

Results: The challenges clinical nurses face in managing patients' pain vary depending on their understanding, knowledge, background, and experience. Three main themes were extracted: (1) Nurses' strategies for pain management, including maximum effort for patient comfort, disengaging without consequence, and ignoring patients' pain and suffering; (2) factors affecting pain control, including individual, organizational, and environmental factors; and (3) loss of professional ethics.

Conclusion: The results of the present study showed that nurses face many challenges in managing patients' pain and acting in accordance with their ethical and professional obligations.

Clinical implications: It is suggested that managers should employ a strategy encompassing the auditing of effective pain management and the promotion of ethical behaviors among nurses caring for patients in pain.

Purpose: This study investigates the nursing care for CT-guided percutaneous balloon compression in treating primary trigeminal neuralgia under local anesthesia and intravenous analgesia.

Design: The study is a retrospective analysis of the clinical and nursing data of 54 patients.

Methods: The analysis focused on preoperative, intraoperative, and postoperative nursing aspects for patients treated from November 2022 to July 2023.

Results: The results showed a high success rate of the procedure with only minor complications. There were no serious adverse events or recurrences observed during the 1-year follow-up period.

Conclusion: The study concludes that comprehensive and high-quality nursing care is essential for the success of CTguided percutaneous balloon compression for trigeminal neuralgia.

Clinical implications: This method is a accurate and costeffective alternative to traditional approaches. However, its successful implementation hinges on higher standards of nursing care, which include meticulous preoperative preparation, vigilant intraoperative monitoring, and thorough postoperative management.

Objectives: To synthesize the current evidence on perioperative pain management in older adults with hip fractures and to provide an evidence-based reference to support clinical decision-making by healthcare professionals.

Methods: This review was conducted in accordance with the evidence synthesis methodology developed by the Joanna Briggs Institute (JBI). Guided by the "6S" evidence hierarchy model, a top-down search strategy was employed to identify evidence related to pain management in older adults with hip fractures. The evidence sources included clinical decision support tools, recommended practices, clinical guidelines, best practice statements, evidence summaries, systematic reviews, and expert consensus statements. The search covered literature from database inception to November 30, 2023. Two reviewers independently screened and appraised the literature, followed by data extraction and synthesis based on the JBI Levels of Evidence and Grades of Recommendation.

Results: A total of 14 papers were included in the analysis, including one clinical decision, one recommended practice, seven guidelines, two expert consensus, one evidence summary, and two systematic reviews. Based on the synthesis and integration of the extracted evidence, five thematic domains were identified: pain assessment, nonpharmacological interventions, pharmacologic interventions, Traditional Chinese Medicine, and health education. A total of 25 best evidence statements were ultimately formulated.

Conclusions: This study summarizes the best evidence for perioperative pain management in elderly patients with hip fractures. The evidence covers key aspects such as optimal timing of pain assessment, appropriate tool selection, and consideration of individualized factors during evaluation. It also addresses nonpharmacological and pharmacological interventions across the preoperative, intraoperative, and postoperative phases. These findings provide a scientific and practical foundation for healthcare professionals to implement systematic and evidence-based pain management strategies in this patient population.

Purpose: To compare the effects of different manual therapy techniques in addition to cervical stabilization exercises on pain, range of motion (ROM), functional status, balance, and quality of life (QoL) in patients with chronic neck pain (CNP).

Methods: Ninety CNP patients were randomly allocated into three groups: joint mobilization (Group 1), classic massage (CM) (Group 2), and connective tissue massage (CTM) (Group 3), all receiving cervical stabilization exercises. Pre- and post-intervention evaluations were conducted over a 4-week period, assessing pain severity, pressure pain threshold (PPT), ROM, functional capacity, balance, and QoL.

Results: Significant enhancements in pain severity, ROM, and functional capacity were observed across all groups (p < .05). Group 1 exhibited improvements in static and dynamic balance with eyes closed (mean change -1.10; 95% CI -1.66, -0.53 and -0.87; 95% CI -1.59, -0.16, respectively). Group 2 displayed increased PPT values for both right and left sides (mean change 4.69; 95% CI 0.98, 8.40 and 3.50; 95% CI -0.15, 7.15, respectively). Group 3 demonstrated dynamic balance improvement in eyes open position (mean change -1.05; 95% CI -2.04, -0.06). QoL improvements were noted in Groups 1 and 3 (p < .05). Significant inter-group differences were observed in PPT values (p = .003, p = .002 for right and left, respectively) and flexion ROM (p = .03).

Conclusion: In the management of CNP, different manual therapy techniques plus cervical stabilization exercises can be considered to reduce pain and improve ROM and function. Joint mobilization and CTM can be preferred to improve balance, and QoL. Moreover, CM can be preferred to increase PPT.

Purpose: This study aimed to investigate the prevalence and risk factors of pregnancy-related low back pain (PLBP) and its impact on quality of life among pregnant women in Taiwan.

Design: This cross-sectional study comprised a convenient sample of pregnant women who visited obstetrics clinics in Taiwan's medical centers and regional hospitals between 2021 and 2022.

Methods: Data on demographics and Pain Visual Analog Scale (PVAS), Brief Pain Inventory (BPI), Oswestry Disability Index (ODI), and World Health Organization Quality of Life Assessment-Brief version (WHOQOL-BREF) scores were collected.

Results: Among the 474 participants, 66.2% reported experiencing PLBP, with back pain being common (87.6%). Three risk factors affecting PLBP identified were gestational weight gain, previous experience of low back pain, and work-related repetitive movements and static posture. For PLBP participants, the mean PVAS score was 3.10 ± 1.88, the mean BPI score was 22.25 ± 18.01, and 36.3% had moderate or severe pain; the mean ODI score was 9.71 ± 7.88, and 32.5% had moderate or severe disability, significantly affecting sleep and normal work, such as standing and lifting. The mean WHOQOL-BREF score was 102.18 ± 11.74, with daily functions mediating the association between PLBP severity and quality of life.

Conclusions: The high prevalence of PLBP affects daily functions, including sleep and normal work, due to the severity of pain, thereby impacting the quality of life. Nevertheless, misconceptions about PLBP often discourage many pregnant women from actively seeking treatment.

Clinical implications: Healthcare providers should actively provide PLBP-related knowledge and offer tailored prevention or treatment strategies to high-risk pregnant women.

Background: Diabetic peripheral neuropathy is a significant cause of chronic pain in patients with type 2 diabetes. Although pharmacological treatments are available, complementary therapies such as reflexology massage may offer additional symptomatic relief. However, evidence on the efficacy of reflexology massage in this context remains limited, particularly among women with type 2 diabetes.

Aim: This study aimed to evaluate the effect of foot reflexology massage on neuropathic pain in women with type 2 diabetes.

Methods: This study was conducted between April 2023 and March 2024. The study was conducted as a randomized controlled trial and included 65 women diagnosed with type 2 diabetes and neuropathic pain, randomized into intervention (n = 33) and control groups (n = 32) using a computerized randomization program managed by an independent researcher. The intervention group received routine treatment plus foot reflexology massage administered by trained nurses, while the control group received routine treatment only. Outcomes were assessed using validated instruments for neuropathic pain and sensory function: Douleur Neuropathique 4 Questions (DN4), a 10-item questionnaire identifying neuropathic pain; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), differentiating neuropathic from nociceptive pain; Visual Analog Scale (VAS), measuring pain intensity on a 0-10 scale; Monofilament test (SWM), evaluating peripheral touch sensation; and Neurothesiometer, assessing vibration perception thresholds. Effect sizes (Cohen's d) and 95% confidence intervals were calculated.

Results: Preintervention measurement characteristics and pain scores did not differ significantly between groups (p > .05). Postintervention, the intervention group demonstrated significant reductions in DNQ4 (p = .001, d = 3.55), LANSS (p = .001, d = 2.34), and VAS scores (p = .001, d = 2.26) compared to the control group. No adverse events related to the intervention were reported.

Conclusion: Foot reflexology massage administered by trained nurses effectively reduces neuropathic pain in women with type 2 diabetes. As a low-cost and accessible therapy, it can serve as a valuable adjunct to routine care and is recommended to be incorporated and maintained in nursing practices for the management of neuropathic pain in individuals with diabetes.