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Previous studies have shown positive results on the use of music as postoperative pain relief. Quantitative studies have examined the effect of music on rated pain and otherparameters such as anxiety, relaxation and blood-pressure. The purpose of this study was to investigate the expectations and experiences of patients and nurses onimplementing music as postoperative pain relief in an orthopedic unit Qualitative design and semi-structured interviews were used to examine expectations and experiences. Five patients and five nurses in the unit were interviewed. Four themes developed during the data-analysis. These themes were “Expectations on music as postoperative pain relief”, “Experiences of music as postoperative pain relief”,“Effects of music as postoperative pain relief” and “Continued implementation of musicas postoperative pain relief”. A general theme was distraction. Both patients and nurses described the distracting ability of music. Music distracted the patients from both painand the unfamiliar environment and provided relaxation. According to the results of this study there is a connection between the distracting effect of the music and pain relief. More research needs to be done to examine how musicaffects the human body and mind.

Class of 2006 Abstract / Objectives: To assess perceived efficacy and patient satisfaction at a single point in time during a course of therapy with a compounded topical formulation containing at least ketoprofen in an anhydrous gel base. Methods: Patients aged 18 and older, currently using one of the topical pain relief compounds of interest obtained from Reed’s Compounding Pharmacy in Tucson, Arizona were recruited and then interviewed (in person or by telephone) for this study. Data collected during patient interviews were recorded on a form designed solely for the purposes of this study. Interview questions pertained to the nature of the participant’s pain, their assessment of their pain both before treatment with the medication of interest and at the time of the interview, frequency and duration of patient use of the pain relief gel, disclosure of any other pain relief medications the patient was using at the time, and their overall satisfaction with the medication. Results: Interviews were conducted with a total of 50 patients with chronic pain conditions representing several different etiologies and anatomical locations. The average pain assessment score at the time of the interview (representing perceived patient pain after use of the topical pain relief compound) was significantly lower than the average before treatment pain assessment score (p<0.001). After treatment with the gel had commenced, perceived pain scores dropped by average of 3.56 units (SD 2.28), or 44%. Increased frequency of application of the topical pain relief gel was not associated with greater pain relief or changes in overall patient satisfaction with the product. A longer duration of use of the topical pain relief was also not associated with greater pain relief or overall patient satisfaction with the product. Whether or not a patient utilized other pain relief medication(s) while undergoing treatment with the topical pain relief gel had no bearing on the assessment of their pain either before use of the gel or at the time of interview. The average overall patient satisfaction with the topical pain relief compound was rated at 6.6 out of a possible 10 units (SD 3.13). Thirty-six patients (72%) rated their satisfaction with the topical medication of interest with a satisfaction score of ≥ 6, 10 patients (20%) rated their satisfaction with a score of 10 (completely satisfied), and 6 patients (12%) rated their satisfaction with a score of 0 (not at all satisfied). It was observed that the lower the perceived pain assessment score at the time of the interview (after using the gel), the greater the patient satisfaction with the product. Additionally, patients were observed to be more satisfied with the product if the difference between their perceived pain assessment scores (before and after) was greater (i.e.: greater patient satisfaction with greater pain relief). Conclusions: Treatment of chronic pain with a topical pain relief compound containing at least ketoprofen in an anhydrous gel base is associated with patient satisfaction and perceived analgesic benefits. During the one-time interview, most patients reported a significant improvement in their pain relief, and the great majority of patients were very satisfied with the compounded topical treatment they received from Reed’s Compounding Pharmacy.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Background: For several decades childbirth educators and midwives have focused on the alleviation or reduction of pain and suffering during the childbirth experience (Brown, Douglas & Flood 2001:1). Nursing professionals who care for labouring women require current, evidence-based knowledge regarding pain management options, including mode of action, benefits, risks and efficacy (Florence & Palmer 2003:238). Objectives: This study examined the effects of non-pharmacological pain relief strategies for pain management during labour. Search methods: The researcher conducted a search between February and May 2010 on PubMed, CINAHL and CENTRAL for randomised controlled trials published from inception to 2010. The Medical Search Headings (MeSH) included non-pharmacological, alternative, pain management, labour, pregnant, complementary, randomised, randomly, midwifery, natural birth, relaxation, breathing, positioning, hypnosis, water birth, acupuncture, aromatherapy. Selection criteria: The studies included reported on pregnant women, primigravida or multigravida, term (37 weeks and more), spontaneous labour (first or second stage) without any complications in previous or current pregnancies. The researcher searched for randomised controlled trials with an intervention and a control group. Due to financial restrictions the researcher assessed studies that were published in English only. Interventions were childbirth education, continuous support, relaxation, breathing techniques, movement and positioning, music, manual healing, aromatherapy, hydrotherapy, hypnosis and acupuncture. Data collection and analysis: Meta-analysis was performed using Relative Risks and 95% Confidence Interval for dichotomous outcomes and Weighted mean differences and 95% Confidence Interval for continuous outcomes. Review Manager (RevMan), a statistical software was used. Where meta-analyses were impossible results were presented in narrative form. The outcome measures were a decreased need for pharmacological pain relief, maternal satisfaction with the overall childbirth experience, length of labour (normal or shorter progress), incidence of postnatal depression, incidence of postpartum haemorrhage, an Apgar score of more than seven at five minutes, resuscitation of the neonate and admission to the neonatal intensive care unit. Results: Thirteen (13) eligible RCT’s were included in the systematic review. Four trials involved hydrotherapy (n=585), two trials involved acupuncture (n=480), two trials involved childbirth education (n=6398), one trial involved continuous support (n=2844), one trial involved aromatherapy (n=513), one trial involved maternal positioning (n=2547), one trial involved music, massage and relaxation (n=90) and one trial involved hypnosis (n=82). In the Freeman trial (1986) women in the hypnosis group required less pharmacological pain relief 15/29 compared to women in the control group 20/36. Women in the intervention group also experienced greater satisfaction with the childbirth experience 15/29 (52%) compared to women in the control group 8/36 (23%). The trials of acupuncture showed a decreased need for pharmacological pain management in Skilnand (2002) (n=208) for epidural 11/106 (10%) for the intervention and 27/102 (26.5%) for the control group as well as Pethidine 15/106 (14%) for the intervention and 36/102 (35%) for the control group. In the Borup trial (2009) it was reported that acupuncture during labour reduced the need for pharmacological pain management for the intervention group 185/314 (58.9%) compared to control 124/149 (83.2%) without affecting the birth outcome. The secondary outcome of length of labour (minutes) in the Skilnand trial is significantly in favour of the acupuncture group with a mean value of 212 (SD, 155), compared to the control group with a mean value of 283 (SD, 225) with a p-value of 0.01. Conclusions: Acupuncture may relieve labour pain and also shorten the duration of labour, and women experience greater satisfaction with the childbirth experience. Hypnosis may decrease the need for pharmacological pain relief requirements, and may also increase an overall maternal satisfaction with the childbirth experience. There is insufficient evidence about the benefits of childbirth education, continuous support, aromatherapy, music, massage, movement and positioning, breathing and relaxation. / AFRIKAANSE OPSOMMING: Agtergrond: Vir talle dekades het die verloskundiges en vroedvroue gefokus op die verligting of vermindering van pyn en lyding gedurende die ervaring van kindergeboorte (Brown, Douglas & Flood 2001:1). Professionele verpleegkundiges wat omsien na vrouens wat kraam het die huidige, bewyslewerende kennis aangaande pynbestuuropsies nodig, insluitende die wyse van optrede, voordele, risiko en effektiwiteit (Florence & Palmer 2003:238). Doelstellings: Hierdie studie het die effekte van nie-farmakologiese pynverligtingstrategieë vir die beheer van pyn gedurende die kraamproses nagevors. Ondersoekmetodes: Die navorser het gedurende Februarie en Mei 2010 ’n ondersoek gedoen na PubMed, CINAHL en CENTRAL vir ewekansigbeheerde proewe gepubliseer vanaf die aanvang tot 2010. Die Mediese Ondersoekhoofde het farmakologiese, alternatiewe, pynbeheer, kraam, swangerskap, komplementêre, ewekansigheid, toevalligheid, verloskunde, natuurlike geboorte, ontspanning, asemhaling, posisionering, hipnose, watergeboorte, akupunktuur en aromaterapie ingesluit. Seleksie kriteria: Die studies het navorsing oor swanger vroue, primigravida of multigravida, tydperk (37 weke en meer), spontane kraam (eerste of tweede stadium) sonder enige komplikasies in vorige of huidige swangerskappe ingesluit. Die navorser het ewekansigbeheerde toetsing met ’n intervensie en ’n kontrole groep ondersoek. As gevolg van finansiële beperkings het die navorser studies wat alleenlik in Engels gepubliseer is, geassesseer. Intervensies soos die opvoeding oor kindergeboorte, deurlopende ondersteuning, ontspanning, asemhalingstegnieke, beweging en posisionering, musiek, handegenesing, aromaterapie, hidroterapie en akupunktuur is bestudeer. Data-insameling en analise: Meta-analise is uitgevoer deur gebruik te maak van Relatiewe Risiko’s en 95% Betroubaarheidsinterval vir tweeledige uitkomste en Gewigdraende gemiddelde afwykings en 95% Betroubaarheidsinterval vir deurlopende resultate. Review Manager (RevMan), ’n statistiese sagteware is gebruik. Waar dit ontmoontlik was om meta-analise uit te voer, was resultate gepresenteer in narratiewe vorm. Die uitkomste meting is ’n afname in die behoefte vir farmakologiese pynverligting, moederskapbevrediging met die algehele geboorteskenkervaring, die duur van die bevalling (normale of korter vordering), gevalle van postnatale depressie, voorkoms van postpartum bloeding , ’n Apgartelling van meer as sewe teen vyf minute, resussitasie van die neonaat en toelating tot die neonatale intensiewe sorgeenheid. Resultate: Dertien (13) geskikte ewekansigbeheerde proewe is ingesluit in die sistematiese oorsig. Vier proewe het hidroterapie (n=585), twee proewe akupunktuur (n=480), twee proewe die opvoeding van kindergeboorte (n=6398), een proef deurlopende ondersteuning (n=2844), een proef aromaterapie (n=513), een proef moederlike posisionering (n=2547), een proef musiek, massering en ontspanning (n=90) en een proef het hipnose (n=82). Die proef vir hipnose het ‘n afname in die behoefte vir farmakologiese pynbeheer met 15/29 vroue in die hipnose groep en 20/36 vroue in die kontrole groep getoon. Vroue in die hipnose groep het ook groter bevrediging gevind met die ervaring van die geboorteskenking met 15/29 (29%) in vergelyking met 8/36 (23%) in die kontrole groep. Die proewe vir akupunktuur het ’n afname in die behoefte vir farmakologiese pynbeheer Skilnand (2002) (n=208), met ‘n gemiddelde waarde van 11/106 (10%) vir epiduraal en 15/106 (14%) vir Pethidien in die intervensie groep en ‘n gemiddelde waarde van 27/106 (26.5%) vir epidural en 36/102 (35%) in die kontrole groep. Borup (2009) (n=384) toon ook ‘n afname in die behoefte van farmakologiese pynbeheer met ‘n waarde van 185/314 (58.9%) in vergelyking met die kontrole groep 124/149 (83.2%). Die sekondêre uitkomste van die duur van die kraamproses (minute) in Skilnand (2002), is noemenswaardig ten gunste van die akupunktuurgroep met ’n gemiddelde waarde van 212 (SA, 155) in die intervensie groep en ’n gemiddelde waarde van 283 (SA, 225) in die kontrole groep met ’n p-waarde van 0.01. Gevolgtrekkings: Akupunktuur mag kraampyn verlig en ook die duur van die kraamproses verkort, vandaar dat vrouens groter bevrediging mag ervaar met die ervaring van geboorteskenk. Hipnose mag die begeerte na farmakologiese pynverligting verminder en sodoende vroue groter ervaring met geboorteskenk mag ervaar. Daar is onvoldoende bewys aangaande die voordele van die opvoeding van kindergeboorte, deurlopende ondersteuning, aromaterapie, musiek, massering, beweging en posisionering, asemhaling en ontspanning.

Bakgrund: Antalet förstföderskor som använder sig av EDA har ökat och idag använder dryga hälften EDA under förlossning. Det är den mest effektiva smärtlindringsmetoden som förlossningsvården har att tillgå. EDA vid förlossning är dock förknippat med biverkningar och risker. Barnmorskor har en viktig roll att ge information och undervisning om smärtlindring till gravida kvinnor. Syfte: Syftet med studien var att undersöka förstföderskors kunskaper och behov av information om EDA inför förlossning. Metod: Studien genomfördes och analyserades med metoden kvalitativ innehållsanalys med induktiv ansats. Semistrukturerade intervjuer genomfördes med åtta förstföderskor. Resultat: De analyserade intervjuerna utmynnade i två huvudkategorier; EDA är en metod med fördelar och nackdelar och Förstföderskor har behov av olika information på olika sätt, med tre, respektive två, tillhörande underkategorier. Konklusion: Kvinnornas kunskaper varierade, och många var osäkra. De hade behov av olika information om EDA på flera olika sätt. De upplevde att det varken fanns tid eller möjlighet för diskussion om EDA med barnmorskor, vilket kunde bidra till en känsla av att inte ha fått tillräckligt med information. Barnmorskor behöver därför blir bättre på att erbjuda förstföderskor information om EDA, men även annan smärtlindring som används under förlossning, förslagsvis genom uttökad tid på MHV. / Background: The number of primparas who use EDA has increased, and today more than half of them use EDA during childbirth. It is the most effective method of pain relief that is available in maternity care. EDA during childbirth is, however, associated with side effects and risks. Midwives have an important role to provide information and education about pain relief to pregnant women. Purpose: The purpose of this study was to investigate primiparas knowledge and need of information about EDA during childbirth. Method: The study was conducted and analyzed by qualitative content analysis method with inductive approach. Semi-structured interviews were conducted with eight primiparas. Results: The analyzed interviews resulted in two main categories; EDA is a method with advantages and disadvantages and Primiparas need different information in different ways, with three and two associated subcategories. Conclusion: The women's knowledges varied, and many were unsure. They needed different information about EDA in several different ways. They felt that there was neither time nor opportunity for discussion about EDA with midwives, which could contribute to a feeling of not having received sufficient information. Midwives must therefore improve in offering primiparas information about EDA, but also other forms pain relief used during childbirth, suggested by extended time at maternal health care.

Painful cutaneous ulcers are a clinical challenge as the pain can be difficult to control, frequently requiring a combination of pharmacological and non-pharmacological measures. There is evidence suggesting topical opioid application might be efficacious in the management of painful cutaneous ulcers, however this is largely based on case reports. Methods A series of clinical and laboratory studies were undertaken to determine the utility of opioids applied topically to painful cutaneous ulcers, these included surveys of hospice admissions to determine the prevalence of painful ulcers and the effective dose of topical opioid; a randomised, double-blind, placebo-controlled crossover trial design to assess the utility of morphine/IntraSite gel mixture, HPLC analysis to determine the mixture’s bioavailability and physical stability, and microbiological studies to determine its microbiological stability. Results A survey of 323 hospice admissions over a two-year period identified 125 patients with 221 ulcers, mostly caused by either pressure (183 ulcers) or trauma (25); 147 (67%) of all ulcers were painful. Compared to placebo, morphine/IntraSite mixture was more efficacious; it was safe and well tolerated in this population. Morphine applied topically appears to have an analgesic effect even at low doses of morphine irrespective of background analgesic medication. HPLC analyses suggested morphine and its metabolites might be detectable in the plasma of patients with large ulcers, but only at low concentrations. In addition morphine/IntraSite gel mixture was physically and, under certain storage conditions, microbiologically stable for 28 days allowing the mixture to be prepared and stored before use. Conclusions The studies confirmed that painful cutaneous ulcers are a significant clinical problem in hospice patients and that morphine/IntraSite mixture can be used safely and effectively in this patient group. Bioavailability studies support the possibility that the opioid analgesic effect is local rather than systemic, and stability studies show the morphine/IntraSite combination, once mixed, can be stored for up to 28 days, allowing the mixture to be prepared and stored before use. Given that ulcers can vary in aetiology, size, severity and temporal characteristics of pain, an individualised titration protocol is recommended. Further research is required to confirm and extend these findings to other ulcers and clinical settings.