Sucrose is a method of pain relief that can be used for children during minor painful procedures. Pain left unrelieved has been found to lead to long-term consequences such as distress, anxiety, needle fear, parental non-adherence with vaccination administration, and avoidance of medical care. Therefore, it is important to ensure pain management methods are provided to infant and toddlers. The purpose of this project was to present a systematic review on the use of sucrose in child in primary care. The comfort theory by Kolcaba served as the theoretical framework in exploring the use of sucrose in children in primary care. A comprehensive search was completed and 37 articles pertaining to the use of sucrose were identified. The articles were appraised using Fineout-Overholt, Melnyk, Stillwell, and Williamson's critical appraisal guide and then categorized using Melnyk and Fineout-Overholt's level of evidence system. This systematic review revealed that 85 percent of the articles identified found sucrose to be an effective method of pain relief for children during minor painful procedures. This systematic review gives a final recommendation that sucrose should be used for pain relief during minor painful procedures for children up to 18 months of age. Future studies should be focused on translating this evidence into practice guidelines to narrow the knowledge to practice gap. The creation of practice guidelines would bring about a positive social change for infants and toddlers by providing pain relief methods such as sucrose in daily practice reducing anxiety and needle fear for children and their parents, increasing vaccine and medical care adherence.

No description available.

Introduction/Background: Chronic widespread pain (CWP) affects around 11% of the population and while aetiology is well documented it has been difficult to translate this into effective management strategies. Patients in clinical trials are known to be different from the patient populations that they represent and treatment preference is one area where they may differ. Treatment preference may also influence outcome, particularly when participants cannot be blinded to treatment allocation. Aims: To assess whether patient treatment preference has an influence on 1. Recruitment, 2. Outcome, and 3. Adherence In a clinical trial of interventions for CWP. Methods: In the MUSICIAN trial, a 2x2 factorial trial of exercise and telephone cognitive behavioural therapy (T-CBT) for CWP, treatment preferences were recorded when eligibility was assessed using a population postal survey. Eligible individuals who did and did not go on to enter the trial were compared to address aim 1. Trial participants were followed up after 6 months of treatment and outcomes were compared according to whether they received their preferred treatment to address aim 2 and T-CBT and exercise logs were used to assess adherence to examine aim 3. Results: Eligible individuals were more likely to be randomised into the MUSICIAN trial if they expressed a treatment preference in the screening questionnaire (Relative Risk 1.46, 95% confidence interval 1.19-1.79). Treatment preferences were also associated with prognostic factors (anxiety and fear of movement). At follow-up participants were more likely to achieve a good outcome (global assessment of change) if they had received their preferred treatment (Relative Risk 2.50, 95% confidence interval 1.54-4.03)and this may be due to those individuals being more likely to adhere to treatment programmes. Conclusions: Wherever possible participant treatment preferences should be recorded prior to randomisation in clinical trials. Additional benefit may be gained in clinical practice by tailoring treatment to patients’ preferences.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in the branch of Anaesthesiology Johannesburg, 2014 / BACKGROUND: Chronic pain is a biopsychosocial phenomenon that can have a profound impact on people’s lives. Internationally, chronic pain is being recognised as a health priority. South Africa is a developing country with limited resources that are directed at catering for a growing population where life threatening conditions like Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS), violent crimes, and poverty predominate. Auditing the Helen Joseph Hospital Pain Management Unit (HJHPMU) is a step towards addressing the paucity of epidemiological data on chronic pain in South Africa. Clinical records are a basic clinical tool that also serves as a medicolegal document. It is essential that these records are legible and complete. AIM: The aim of this study was to describe the profile of chronic pain patients at the HJHPMU for 2011 and to determine the adequacy of record keeping. METHODOLOGY: A retrospective, contextual, descriptive study design was utilised. A consecutive sampling method was used and the study sample included the HJHPMU database and all files of adult patients that attended the HJHPMU during the period January 2011 to December 2011. Patient files were excluded from the audit if insufficient data were found. Descriptive statistics were used to analyse the data obtained during the study. Frequencies and percentages have been reported. A Chi-­‐squared test was utilised to analyse any association between gender and type of pain. RESULTS: There were 475 patients in the HJHPMU database for the year 2011 and 190 of these patients were excluded from the study due to illegible handwriting, duplication in the HJHPMU database, missing data such as no hospital number recorded, no initials to a surname, or the file not found. This resulted in a study sample of 285 patients. The HJHPMU had 215 (75,44%) pre-­‐existing patients and 70 (24,56%) new patients during the year 2011. The preponderance of patients were in the 41-­‐60 year age group, with 146 (51,23%) patients presenting in this age group. Of the 285 patients in the study, 91 (31,93%) patients were male and 194 (68,07%) were female. The most common complaint was of lower back pain (LBP). There were 97 (34,04%) patients with a diagnosis of spinal pain and 59 (20,70%) with Failed Back Surgery Syndrome (FBSS). There were 164 patients with a relevant surgical history. This included 46 (28,05%) patients that had been involved in a traumatic event, 47 (16,49%) patients that had surgery other than spinal surgery that was relevant to their pain diagnosis, and 71 patients (43,29%) that 4 had spinal surgery that was relevant to their diagnosis. A Chi-­‐squared test was performed on the relationship between gender and the type of pain, and a p value of 0.001 was found. When relating the type of pain with age, mixed pain and nociceptive pain was found to be most common in those aged >60 years (n=26), whereas neuropathic pain was found to be most common in the 41-­‐60 year age group (n=43). CONCLUSION: With the limited data from this study, the profile of patients with chronic pain in South Africa seems to not differ grossly from data collected internationally. The most pertinent finding of this study is the inadequacy of record keeping.

M.Med.(Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2011 / BACKGROUND Multiple studies have been conducted comparing the efficacy and duration of analgesia obtained from spinal anaesthesia containing local anaesthetics as well as opioids. The literature available has not considered the individual‟s HIV status as a variable. Postoperative analgesic duration and requirements in this group of patients may differ due to the occurrence of acute and chronic pain syndromes, pain arising from the disease itself, side effects of treatment for HIV infection, or opportunistic infections. Response to opioid analgesia may be altered due to previous opioid exposure, potential increase in nociception, drug interactions and emotional status. OBJECTIVES The primary objective of this study was to determine the time to post-operative analgesic request in HIV-positive and negative individuals having caesarean sections under spinal anaesthesia containing bupivacaine or bupivacaine and fentanyl. The secondary objectives of this study were to determine if factors such as height, ethnicity, level of education, CD4 count, and antiretroviral therapy impacted on the duration of analgesia obtained.

A research report submitted tot the Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesia. Johannesburg, 2014 / Background: Post-operative pain is often undertreated, exposing patients to significant morbidity. The appropriate management of pain depends upon the accurate assessment thereof, however, this is difficult during general anaesthesia due to many confounders and thus intra-operative analgesia is administered according to multimodal “recipes” and changes in vital signs. Aim: To determine whether intra-operative respiratory rate in a patient under general anaesthesia is a valid indicator of post-operative analgesic adequacy. Method: The respiratory rates of 60 consenting adult female patients undergoing standardised general anaesthesia for elective breast surgery were measured. Post-operatively, each patient was assessed for the presence of pain using a Verbal Numeric Rating Scale (VNRS). Results: Spearman correlation coefficient of 0.62 was calculated between the intra-operative respiratory rates and post-operative VNRS scores. A ROC curve (with AUC equals 0.77) was plotted to test the validity of respiratory rate as a predictor for post-operative pain, with a VNRS score greater than three indicating unacceptable pain. The suggested cut-off point for respiratory rate to predict unacceptable pain is greater than or equal to 17 breaths per minute. Conclusion: The adequacy of post-operative analgesia may be predicted intra-operatively from the respiratory rate if patients are allowed to breathe spontaneously. This provides anaesthetists with a reliable, valid, affordable and easy method of titrating analgesia intra-operatively.

by Cecilia Y.Y. Webb. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1988. / Bibliography :leaves 219-237.

Background and aims: Pain management programmes provide effective interventions for people with chronic pain, but effects are modest, and not all participants benefit. The current study aims to investigate the role of acceptance and cognitive representations i.e. beliefs about pain, in engagement, and outcome, of this kind of intervention. Design and participants: A quantitative design was used to investigate whether acceptance and cognitive representations of pain predict engagement and outcome of intervention, whether acceptance and cognitive representations change during intervention, and the relationship of acceptance with five dimensions of belief. Participants were 116 patients referred for assessment to a pain management programme. Measures Questionnaire measures of acceptance of pain, and cognitive representations of pain were used as predictor variables. Measures of distress, self-efficacy and physical function were used as outcome measures. Pain severity and waiting time were also measured as potentially confounding variables. Results: Measures of acceptance and cognitive representations of pain did not predict who would complete the intervention. Increases in acceptance, and decreases in perceived consequences of pain, and pain identity, occurred during the intervention. Lower acceptance was related to more serious perceived consequences and greater pain identity, but not with beliefs about cause or expected duration of pain, or beliefs in control and cure. Implications: Interventions aiming to increase acceptance by changing beliefs about perceived consequences of pain and pain identity may be useful. Further research is needed to explore the nature of acceptance, and the role of different dimensions of belief in affecting functioning, in chronic pain populations.

No description available.

Even though pain is common and often chronic in people living with HIV/AIDS (PLWHA), the management of pain is complicated and frequently woefully inadequate. Many factors influence the way PLWHA experience and communicate their pain. These factors can be categorized as both physiological and emotional. PLWHA often resort to self-care activities to control their pain because of the pervasive lack of adequate pain management by health care providers. The purposes of this study were to increase understanding of the pain management experiences in people living with HIV/AIDS (PLWHA) who report chronic pain and to elucidate the factors that influence this experience. Recruitment was conducted at 3 locations in Central Texas, USA; serving over 3,000 clients/year. A cross-sectional descriptive design and open-ended questions were used to explore PLWHA experiences in reporting chronic pain needs for at least 3 months and to describe pain management choices (self-care and/or seeking care activities) and communication with health care providers. Variables of interest were assessed with paper-pencil surveys (HIV-Self Efficacy Questionnaire, Coping Inventory for Pain in Persons Living with HIV/AIDS and Pain Self-Efficacy Questionnaire) and open-ended questions. Interviews ranged from 7-35 minutes each. One hundred PLWHA participated in the study, 53% African-American, 21% Hispanic and 25% Caucasian. They were primarily male (66%), 34% female, reported a mean age of 48 years and a mean of 13 years living with HIV. 83% of the participants rated their pain as consistently moderate to high levels; 82% rated they are likely to “tolerate the pain.” A majority of the participants (63%) reported they exercise or walk as a way of self-managing their pain. There was a significant association between use of pain management choices (self-care and/or seeking care activities) and confidence in performing life activities (r= 0.344, p<0.05). These findings indicate a need for health care providers to move beyond quantitative measures for this complex problem. Clinicians can use this information to understand the coping strategies used by PLWHA to manage pain. Future implications will be to develop appropriate pain management approaches (behavioral and pharmacological) for health care providers to improve control of chronic pain in PLWHA. Longitudinal studies are needed to explore the causative relationships between pain management choices (self-care and/or seeking care activities) and functional outcomes in PLWHA. / text