Ambulansuppdrag med smärtpåverkade patienter ingår i ambulanssjuksköterskans vardag. Metoder för smärtlindring finns i form av olika läkemedel med varierande effekt, biverkningar och tillslagstid. Metoxifluran har använts länge i framförallt Australien men på senare tid även kommit till Sverige. Skillnaden från konventionella smärtlindrande läkemedel i ambulanssjukvården är att metoxifluran inhaleras och doseringen styrs av patienten själv. Syftet med denna litteraturöversikt är att undersöka patientnyttan i användandet av metoxifluran i ambulanssjukvården. Metoden som har använts är en litteraturöversikt där tolv vetenskapliga artiklar ligger till grund att beskriva patientnyttan i användandet av metoxifluran. Sökning av artiklar har genomförts i databaserna Pubmed och Cinahl samt genom en granskning av inkluderade artiklars referenslistor. Samtliga artiklar har kvalitetsgranskats enligt mall från Sophiahemmet Högskola. Resultatet visar på flertalet positiva effekter för patienten i användandet av metoxifluran, där tid till smärtlindrad patient, patientnöjdhet och effekt på smärtan var övervägande. Resultatet visade även enstaka negativa effekter för patienten där fysiologiska effekter och dålig smärtlindringseffekt identifierades. Slutsatsen är att metoxifluran är ett läkemedel med positiva effekter för smärtpåverkade patienter och ett bra komplement till de konventionella läkemedel som används inom ambulanssjukvården idag. / Ambulance callouts with pain-affected patients are part of the paramedic nurse's everyday life. Methods for pain relief are available in the form of various drugs with varying effects, side effects and onset time. Methoxyflurane has been used for a long time, especially in Australia, and is also utilized in Sweden nowadays. The difference from conventional analgesia in ambulance care is that methoxyflurane is inhaled and the dosage is controlled by the patients themselves. The purpose of this literature review is to investigate the patient benefit in the use of methoxyflurane in ambulance care. The method that has been used is a literature review where twelve scientific articles serve as the basis for describing the patient benefit in the use of methoxyflurane. The search for articles has been carried out in the databases Pubmed and Cinahl and a review of the reference lists of included articles has been performed. All articles have been quality checked according to a template from Sophiahemmet university. The results show mostly positive effects for the patient benefit in the use of methoxyflurane, where time to pain relief for the patient, patient satisfaction and effects on pain were predominant. The result also gave occasional negative effects for the patient benefit, where physiological effects and a lack of effect are included. The conclusion is that methoxyflurane is a drug with positive effects for patients in pain and a good complement to the conventional drugs used in ambulance care today.

Bakgrund: I Sverige avlider ca 90 000 personer årligen, varav cirka 80% är i behov av palliativ vård. Smärta är ett av de vanligaste symtomen för patienter i palliativ vård. Studier har visat att många personer dör med smärta trots ordinerade vidbehovsläkemedel. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av smärtlindring till patienter på hospice. Metod: Semistrukturerade intervjuer genomfördes med fem sjuksköterskor på hospice. Intervjuerna transkiberades ordagrant och analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra katergorier och elva underkategorier. Kategorierna var; bedöma behov av smärtlindring, arbeta i team för att lindra smärta, arbeta för smärtlindring och hantera känslor i arbetet. Konklusion: Bedömning av smärta med skattningsinstrument är viktigt för att kunna ge adekvat smärtlindring. Ökad kunskap om skattningsinstrument behövs för att dessa ska användas korrekt. Sjuksköterskor behöver ökad kunskap om farmakologiska och icke farmakologiska metoder för att lindra smärta. Ett välfungerande team med olika kompetenser ökar möjligheterna för adekvat smärtlindring. / Background: In Sweden, about 90,000 people die annually, of wich about 80% need palliative care. Pain is one of the most common symptoms for patients in palliative care. However, earlier studies have shown that many people die with pain despite prescrition of individual medications as needed. Aim: The aim of this study was to describe nurses´experiences with pain relief to patients in hospice. Methods: Semi-structured interviews were conducted with five nurses at the hospice. The interveiws were transcribed verbatim and analyzed with qualitative content analysis. Results: The ananlysis resulted in four categories and eleven subcatergories. The categories were; assess the need for pain relief, work in teams to relieve pain, work for pain relief and manage emotions at work. Conclusion: The use of pain assassment scales is important to provide adequate pain relief. Increased knowledge of assessment instruments is needed for these to be used correctly. Nurses need increased knowledge of pharmacological and non-pharmacological methods to relieve pain. A well-functioning team with different competencies increases the possibilites for adequate pain relief.

Bakgrund: Utöver information från barnmorska, offentliga diskussioner samt samtal med släkt och vänner söker de flesta kvinnorna information om smärtlindring på sociala media om val av smärtlindring under förlossningen. Flertalet kvinnor vill använda någon typ av smärtlindring och förväntar sig att själva välja.   Syfte: Syftet var att belysa föderskors upplevelse av att ej blivit lyssnade på i val av smärtlindring under sin förlossning. Metod: Netnografisk metod användes. Författaren verkade som dold observatör på två internettbaserade forum. Inläggen som användes i studien var skrivna av anonyma deltagare. Kozinets (2015) dataanalysmodell användes för att analysera resultatet. Resultat: Kvinnor i forumen upplevde att de inte fått föra sin talan angående val av smärtlindring under förlossningen. Barnmorskor hade tagit beslut utan förklaring till varför och utan deras medgivande. Kvinnor kunde både känna sig nekade och påtvingade smärtlindring. De berättade om situationer då sjukvårdspersonalen inte bemött dem på ett professionellt sätt, vilket ledde till en negativ förlossningsupplevelse. Slutsats: Det är av stor vikt att kvinnan får föra sin talan under förlossningen. Rätten om självbestämmande ska följas och smärtlindringen behöver anpassas personligen till varje kvinna. Detta för att skapa god förlossningsvård. Mer kunskap inom ämnet obstetriskt våld behövs så att det ej uppstår. / Background: In addition to information from midwives, public discussions and conversations with family and friends, most women seek information about pain relief on social media about choosing pain relief during childbirth. Most women want to use some type of pain relief and expect to choose for themselves. Aim: The aim of the study has been to highlight the experience of not being listened to regarding choice of pain relief when giving birth. Method: A netnographic study was used. The author acted as an observer and conducted a hidden study on two internet-based forums. The posts that were used in the study was written by anonymous participants. Kozinets (2015) data analysis model was used to analyse the result. Outcome: The women in the forums experienced that they were not able to speak for themselves regarding their choice of pain relief when giving birth. The midwives had already made the decision without any explanations or consent from the women. The women could feel that pain relief was forced on them or that it was denied. They told stories about situations where the health care  personal  had not treated them in a professional way, which led to a negative birthing experience. Conclusions: It is of great importance that the women can speak for themselves during the childbirth. The right to decide for oneself shall be respected, and the choice of pain relief needs to be individually adapted for each woman. This is to create a good obstetric care for women. More knowledge regarding obstetric violence is needed so that the health care can prevent this from occurring.

Background: Good pain relief can reduce suffering, decrease the prevalence of postoperativecomplications and shorten the hospital stay. The nurse has an important responsibility toevaluate and meet the patient's need for pain relief. There exists several shortages regarding how this is managed today and a need for development of the organization as well as pain reliefin practice. Investigation of patients' experiences of post-operative pain and pain relief can increase the understanding of what it means to have pain and what factors are considered important for good postoperative pain relief. The frame of reference for this article is Katie Eriksson's theory about human suffering.  Aim: The aim was to describe patients' experiences of post-operative pain and pain relief. Method: The study was a qualitative literature study with ten original articles found via PubMed and CINAHL. A content analysis was used. The quality control was performed in accordance to SBU:s form for quality in original articles by qualitative methodology. The content analysis was implemented using the methodology by Forsberg and Wengström. Result: Patients who were sufficiently informed both verbally and by writing experienced better control over the pain. Lacking information and prior experiences of side effects loweredthe expectations of pain relief. The expectations were also influenced by the patient'supbringing and environment. Healthcare personnel who took responsibility and had goodpersonal treatment increased the feeling of safety. Factors that worsened the pain relief and the experience of pain were difficulties in describing the pain, lack of information, stressfulworking conditions for the personnel, side effects of the medicines and a willingness to meet the expectations of the healthcare personnel. Conclusion: Pain is an individual experience and pain relief is a complex field. There existsseveral factors that promote respectively exacerbate the experience of pain and pain relief. The factors show the significance of nurses´ responsiveness and to work in partnership with thepatient. It also indicates a need for change regarding the high workload and lack of routines inpain relief care. Keywords: Pain relief, patient experience, postoperative pain.

Bakgrund: Att lindra smärta är en av sjuksköterskans vanligaste arbetsuppgifter. Opioider är en vanlig ångest och smärtlindring men är problematisk då det finns ett omfattande substansmissbruk världen över. Palliativ vård förekommer när sjukdomen ej går att bota och att sjukdomen kommer leda till patientens död. Det finns ett utbrett användande av opioider inom den palliativa vården. Syfte: Studien avser att ge en översikt kring sjuksköterskans erfarenheter av smärtbehandling med opioider inom palliativ vård. Metod: Allmän litteraturstudie med kvalitativ ansats med systematisk dataanalys. Studien följde Polit & Becks tiostegsmodell (2020) och analyserades med innehållsanalys enligt Graneheim & Lundman (2003). Resultat: Efter den tematiska analysen framkom teman innehållande ”Komplexiteten med palliativ vård”, ”Opioiders potential och risker”, ”Förutsättningar och kompetenser”. Subteman framkom innehållande “Svårnavigerade etiska dilemman”, “Utmaningar i livets slutskede”, “Potentiellt riskfylld administrering”, “I syfte att minska lidande”, “Vikten av lyhördhet från läkarna”, “Komplexa smärtbedömningar”, “Trygghet och kompetens genom arbetserfarenhet”. Slutsats: Mer kunskap och kompentensutveckling för att sjuksköterskan ska kunna behandla patientens behov av smärtlindring utan att känna rädsla och okunskap inför risken att administrera en felaktig dos. / Background: Relieving pain is one of the nurse's most common tasks. Opioids are a common anxiety and pain reliever but are problematic as there is extensive substance abuse worldwide. Palliative care occurs when the disease cannot be cured and the disease will lead to the patient's death. There is widespread use of opioids in palliative care. Purpose: This study aims to provide an overview of what the research says about the nurse's experiences of pain treatment with opioids in palliative care. Method: General literature study with a qualitative approach with systematic data analysis. The study followed Polit & Beck's ten-step model (2020) and qualitative thematic analysis according to Graneheim & Lundman's (2003) analysis method. Results: After the thematic analysis, themes emerged containing "The complexity of palliative care", "Opioids' potential and risks", "Prerequisites and competences". Subthemes emerged containing "Difficult to navigate ethical dilemmas", "Challenges at the end of life", "Potentially risky administration", "In order to reduce suffering", "The importance of responsiveness from doctors", "Complex pain assessments", "Safety and competence through work experience". Conclusion: More knowledge and competence development so that the nurse can treat the patient's need for pain relief without feeling fear and ignorance about the risk of administering an incorrect dose.

Introduktion: Smärta är en subjektiv och individuell upplevelse för människan. Postoperativ smärta är ett underprioriterat och ett underbehandlat problem som kan den leda till negativa konsekvenser och komplikationer för patienten.  Syftet: Att beskriva hur vuxna patienter upplever sin postoperativa smärta och smärtlindring.  Metod: Allmän litteraturstudie med beskrivande design tillämpades och datainsamling genomfördes från nio vetenskapliga studier med kvalitativ ansats från databaserna CINAHLoch PubMed. Kvalitetsanalys genomfördes med hjälp av Statens beredning för medicinsk och social utvärdering (SBU:s) granskningsmall, för studier med kvalitativ ansats. En induktiv resultatanalys användes för att uppvisa patienters egna upplevelser av postoperativa smärta och smärtlindring. Resultat: Sex kategorier framkom: två kategorier beskrev upplevelser av smärta och fyra kategorier beskrev upplevelser av smärtlindring. Smärtans kategorier var följande: Att bli bekräftad eller inte av vårdpersonalen och Smärtupplevelserna är olika. Smärtlindringens kategorier var följande: Egenhantering, Att uppleva farmakologisk smärtlindring, Hur bemötande kan påverka upplevelsen av smärtlindring och Vikten av information.  Slutsats: Patienter upplevde smärta som inte togs på allvar och där de hade önskat att sjuksköterskan skulle varit mer tillgänglig för den faktiska upplevelsen av smärta. Patienter upplevde även en okomplicerad smärta postoperativt samt att de fick stöd från sjuksköterskan. Postoperativ smärtlindring beskrevs som att de velat ha kontroll och velat behandla den icke farmakologiskt, dels för rädsla för eventuella biverkningar, dels för okunskap och otillräcklig information om den farmakologiska smärtlindringen. Det har beskrivits att patienter har varit nöjda och haft en upplevelse av att sjuksköterskan har gjort allt de kunnat för att hjälpa patienten med den postoperativa smärtlindringen. / Introduction: Pain is a subjective and individual experience for humans. Postoperative pain is an under-prioritized and under-treated problem that can lead to negative consequences and complications for the patient. Aim: The aim of the study was to describe how adult patients experience their postoperative pain and pain relief. Method: A general literature study with a descriptive design was applied and data collection was carried out from nine scientific studies with a qualitative approach from the databases CINAHL and PubMed. The quality analysis was done with the help of the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU’s) review template for studies with a qualitative approach. Analysis was carried out with inductive content analysis to reveal patients' own experiences of postoperative pain and pain relief. Results: Six categories emerged in the results of the study, two categories described experiences of pain and four categories described experiences of pain relief. The pain categories were as follows: To be confirmed or not by the care staff and The pain experiences is various. The pain relief categories were as follows: Self-management, experiencingpharmacological pain relief, How treatment can affect the experience of pain relief and The importance of information.  Conclusion: Patients experienced pain that was not taken seriously and where they would have wished that the nurse would have been more available for the actual experience of pain. Patients also experienced uncomplicated pain postoperatively and received support from the nurse. Postoperative pain relief was described as wanting to have control and wanting to treat it non-pharmacologically, partly for fear of possible side effects, partly because of ignorance and insufficient information about the pharmacological pain relief. It has been described that patients have been satisfied and had an experience that the nurse has done everything they could to help the patient with the postoperative pain relief.

Bakgrund: Smärta är ett vanligt förekommande symtom hos den prehospitala patienten. Trots detta är det vanligt förekommande att smärtan underbehandlas eller inte behandlas alls. Underbehandlad smärta kan ha flera negativa konsekvenser för patienten på längre sikt, såsom kroniska smärtor och posttraumatiskt stressyndrom. Sjuksköterskan har ett ansvar att bedöma och behandla patientens smärta för att lindra det lidande som uppstår i samband med skada eller sjukdom. Syfte: Att undersöka faktorer som påverkar patientens smärtlindring inom prehospital akutsjukvård. Metod: En litteraturöversikt med integrerad analys genomfördes. Resultat: Sjutton artiklar inkluderades i litteraturöversikten. Två kategorier med två underkategorier vardera identifierades. Flera externa och mellanmänskliga faktorer som påverkar hur väl patienten som omhändertas i den prehospitala akutsjukvården smärtlindras. Ambulanspersonalens utbildningsnivå, erfarenhet och tillgång till resurser som läkemedel och stöd från kollegor men också attityder och förmåga att bedöma smärta hos olika patientgrupper spelar en roll. Patientfaktorer som smärtbeteende och kommunikationsförmåga påverkar också smärtbehandlingen. Slutsats: Det finns flera faktorer som påverkar patientens smärtlindring inom den prehospitala akutsjukvården, resultatet av denna litteraturöversikt ger en inblick i dessa. Ambulanspersonalens utbildning, erfarenhet och kunskap visade sig vara av betydelse för patientens smärtlindring och risken för oligoanalgesi, barn och personer med missbrukssyndrom visade sig vara särskilt utsatta grupper. Ambulanspersonalens inställning och attityder såväl som resurser, transporttid och vårdmiljö inverkar på smärtbehandling inom akut prehospital miljö. Aktiv fortbildning av ambulanspersonal gällande smärtbehandling och ett holistiskt omhändertagande utifrån patientens unika behov är av stor vikt för att uppnå effektiv smärtlindring och minskat lidande för patienter med akut smärta som omhändertas inom prehospital akutsjukvård. / Background: Pain is a common symptom in the prehospital patient. Despite this, it is common for the pain to be undertreated or not treated at all. Undertreated pain can have several negative consequences for the patient in the long term, such as chronic pain and post- traumatic stress disorder. The nurse has a responsibility to assess and treat the patient's pain in order to alleviate the suffering that occurs in connection with injury or illness. Aim: To examine factors that affect the patient's pain relief in prehospital emergency care. Method: A literature review with integrated analysis was conducted. Results: Seventeen articles were included in the literature review. Two categories with two subcategories each were identified. Several external and interpersonal factors that influence how well the patient cared for in the pre-hospital emergency medical care is relieved of pain. The ambulance staff's level of education, experience and access to resources such as medicines and support from colleagues but also attitudes and ability to assess pain in different patient groups play a role. Patient factors such as pain behavior and communication skills also affect pain management. Conclusion: There are several factors that affect the patient's pain relief in pre-hospital emergency care, the results of this literature review provide an insight into these. The training, experience and knowledge of the ambulance staff proved to be important for the patient's pain relief and the risk of oligoanalgesia, children and people with drug addiction proved to be particularly vulnerable groups. The attitude and attitudes of the ambulance personnel as well as resources, transport time and care environment influence pain management in the acute prehospital environment. Active continuing education of paramedics regarding pain management and holistic care based on the patient's unique needs is of great importance to achieve effective pain relief and reduced suffering for patients with acute pain who are cared for in pre-hospital emergency care.

The pain relieving efficacy of music listening combined with vibrotactile cutaneous stimulation was determined. Music with mechanical vibration (30min. session; average amplitude of 26μm; frequency range of 60-600Hz.) was applied to subjects with rheumatoid arthritis using the Music Vibration Table (MVT). Scores from pain relief visual analogue scales (VAS) and McGill Pain Questionnaires (MPQ) were compared to groups with music alone and placebo. ANOVA and post hoc analysis indicated that VAS scores from music with vibration were significantly greater than music alone or placebo. MPQ scores also indicated larger percentages of change in pain perception for the music with vibration condition. However, subjects receiving music alone showed a large percentage of change on the affective dimension of the MPQ. This investigation supports the application of music with a controlled, measurable music vibration for the relief of pain. The results of this study warrant further evaluation and development of treatment protocols using music and music vibration.

BACKGROUND:People who have extremely high arched feet or pes cavus often suffer from substantial foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention.METHODS:Plantar pressure data from a randomized controlled trial of 154 participants with painful pes cavus were retrospectively re-analyzed at baseline and three month post CFO intervention. The participants were randomized to a treatment group given CFO or a control group given sham orthoses.RESULTS:No relationship between change in pressure magnitude and change in symptoms was found in either group. However, redistribution of plantar pressure, measured with the Dynamic Plantar Loading Index, had a significant effect on pain relief (p=0.001). Our final model predicted 73% of the variance in pain relief from CFO and consisted of initial pain level, BMI, foot alignment, and changes in both Dynamic Plantar Loading Index and pressure-time integral.CONCLUSION:Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures. Results of this study add to the growing body of literature providing mechanistic support for CFO providing pain relief in painful foot conditions. The proposed model may assist in better designing and assessing orthotic therapy for pain relief in patients suffering painful cavus foot deformity.TRIAL REGISTRATION:Randomized controlled trial: ISRCTN84913516

Pain is the primary reason why patients seek medical care and there is a great unmet need for the development of pain relieving medications. The treatments that are currently available either have limited efficacy or are accompanied by a multitude of unwanted side effects. However, discovering novel therapeutics for the treatment of pain has been challenging. Part of the reason for this may be that that the ways in which pain is assessed in the preclinical setting are different from the way that it is evaluated clinically in human trials. The most common method for evaluating pain in preclinical models is to measure responses to evoked stimuli. However, a change in the threshold of response to evoked pain likely does not measure whether the unpleasant component of pain has actually been reduced. The most clinically relevant question for pain is whether the treatment actually makes the patients "feel better". Here, we demonstrate that the aversiveness of pain can be captured using motivated behavior to seek pain relief. We used conditioned place preference (CPP) to establish that animals with ongoing pain will seek a context that has been paired with effective pain relief, likely as a result of negative reinforcement. These studies allowed for mechanistic investigation. Our results show that: 1) effective pain relief can be achieved by either blocking noxious peripheral input or by directly attenuating pain related unpleasantness in the brain, and 2) pain relief is rewarding and activates the reward circuitry. These studies provide a basis for development of a future platform for drug discovery for pain.