Background: As the number of older adults in Thailand continues to increase, along with increased incidence of surgical intervention that causes pain, the quality of pain care in older adults is needed. Nurses are primarily responsible for assessing and managing pain in older adults (Jose Closs, 2008; Prowse, 2007). The use of evidence-based practices (EBPs) improves quality of care and saves healthcare cost. However, in Thailand where empirical study of using EBP related to pain in older adults is limited, research to understand how Thai nurses use EBP acute pain in older adults is needed.Purpose:The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Thai nurses on using EBP for assessing and managing acute pain in postoperative older adults.Method:A descriptive exploratory survey was conducted in 8 mid and large-size hospitals in Thailand. The Acute Pain EBP Questionnaire (APEBPQ) (Suwanraj, 2009) was distributed to 240 Thai nurses. 236 questionnaires were returned with the response rate of 98.3 percent. Open-ended questions related to barriers and facilitators of using EBPs were coded to identify major themes. MANOVA was performed to explore the differences between years of nursing experience on perceived barriers and facilitatorsResultsThe majority of participants are female (96.8%) with mean age 35.5 years (range=23-54). Thai nurses reported using 51/53 recommendations from EBPG Acute Pain most of the time/always (95%). Using an equianalgesic table (1.80±1.16) and assessing MMSE in older adults with postoperative pain (1.74±1.15) were occasionally used. Research reports published in English was the greatest barriers. Nurses perceived greatest support from a Head ward than other colleagues. Nurses with 11-20 years of nursing experience had higher reported barriers than those with 1-10 years of nursing experience.Practice Implications: This study will provide important information on barriers and facilitators of using EBPs related to pain assessment and pain management in Thailand. The results of the study will be used to develop strategies to promote the use of EBPs acute pain among Thai nurses who provide nursing care for postoperative older adults.

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Akut smärta är det vanligast förekommande symtom som den prehospitala akutsjukvården ställs inför. Behandlingsriktlinjerna presenterar intranasalt Fentanyl som ett alternativ för akut smärtlindring. Då det finns ett begränsat utbud av studier utförda på vuxna och inom prehospital akutsjukvård var syftet med studien att beskriva effekter av intranasal administrering av Fentanyl i prehospital akutsjukvård. Studien genomfördes med en kvantitativ metod och med en retrospektiv, deskriptiv design. Studien baserades på en granskning av 15 patientjournaler från Ambulanssjukvården i Region Halland och deras journalsystem Paratus. Journaler som inkluderades var de där Fentanyl administrerat. Resultatet visar att en majoritet av patienterna i studien drabbats av muskeloskeletal smärta. Resultatet visade på dokumentationsbrister i granskade patientjournaler. Vidare forskning av Fentanyl i den prehospitala akutsjukvården samt översyn av följsamhet till dokumentationsrutiner är nödvändig. / Acute pain is the most common symptom in the prehospital emergency care. The treatment guideline presents Fentanyl as an alternative for treating acute pain. As there is a limited range of studies conducted in adults and in prehospital emergency care the purpose of the study was to illustrate the effects of intranasal administration of Fentanyl in the prehospital emergency care. The study was conducted by a quantitative method and with a retrospective, descriptive design. The study was based on a review of patient records from the Ambulance Service in the Region of Halland and their record system Paratus. Fifteen patient records were Fentanyl was administrated were included in the study. The result showed that a majority of the patients included in the study suffered from musculoskeletal pain. The result showed a lack of documentation in the reviewed records. Further studies and an overview of the compliance of the routines for documentation as well are necessary.

Inledning: Forskning visar att smärta vid stora trauman är underbehandlat, vilket kan ge ett förlängt sjukdomsförlopp och leda till komplikationer för patienten. Smärtbedömning är en viktig del i smärtbehandlingen och kan göras med hjälp av observationer av fysisk status och smärtskattningsinstrument. Eftersom ett stort trauma även innebär en psykologisk påfrestning för patienten är det viktigt att lindra både smärtan och det psykiska lidandet. Syfte: Att beskriva ambulanssjuksköterskors uppfattningar om traumapatienters upplevelser av smärta samt beskriva ambulanssjuksköterskors erfarenheter av smärtbehandling och omvårdnadsåtgärder som lindrar lidande hos dessa patienter. Metod: En intervjustudie med elva ambulanssjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Ambulanssjuksköterskans arbete vid smärtlindring vid stort trauma präglades av avvägningar och prioriteringar. Dessa gjordes utifrån ambulanssjuksköterskans egna bedömningar samt de riktlinjer som fanns inom ambulanssjukvården. Omvårdnadsåtgärder var lika viktiga som de farmakologiska åtgärderna, i arbetet för att lindra patientens smärta och lidande. Majoriteten av ambulanssjuksköterskorna upplevde smärtan vid stort trauma som underbehandlad. Detta på grund av otillräckliga läkemedelsdoser men också på grund av prioritering av livsuppehållande åtgärder. Slutsats: Studiens resultat visar att ambulanssjuksköterskans arbete stämmer väl överens med kompetensbeskrivningen. Smärtlindring vid stora trauman är komplext och de upplevda hindren är många. Ambulanssjuksköterskans egen bedömning, med utgångspunkt från gällande riktlinjer, är kärnan i deras arbete med traumapatienter. Smärtlindring vid stora trauman är ett viktigt ämne och ett relativt outforskat område. Det är därför angeläget med vidare forskning. / Introduction: Research shows that pain at major traumas are poorly treated, which can lead to a prolonged course of the disease and lead to complications for the patient. Pain assessment is an important part of pain treatment and can be done either through observations of the patient’s physical status or via pain assessment tools. A major trauma involves also a psychological stress for the patient, therefore it’s important to relieve both the physical pain as well as the mental suffering. Aim: To describe ambulance nurses’ perception regarding trauma patients’ experiences of pain and to describe ambulance nurses’ experiences of pain treatment and nursing care that ease the suffering for these patients. Method: An interview study with eleven ambulance nurses. The interviews were analyzed by using qualitative content analysis. Result: Ambulance nurses’ work with pain relief at major traumas was characterized by balancing decisions and prioritizations. These were made based on the ambulance nurses’ own judgment combined with the guidelines for the ambulance health care. The nursing care was just as important as the medical treatment in the work to ease the patient’s pain and suffering. The majority of the ambulance nurses experienced that pain at major traumas was poorly treated. The reason for this opinion was due to a restricted use off analgesics, but also due to prioritization of life support care. Conclusion: The study´s findings shows that ambulance nurse’s work are in line with the ambulance nurse’s competence description. Pain treatment at major traumas is complex and the perceived difficulties are many. The ambulance nurses’ own evaluations, with the associated guidelines, constitute the core work with trauma patients. Pain relief at major traumas is an important and relatively unexplored area and it is therefore desirable with further research in this area.

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

Gabapentin is an anticonvulsant that has become a treatment option for several indications that are not approved by Health Canada. Commonly, gabapentin is prescribed for neuropathic pain and anxiety disorders. The objective of this dissertation was to evaluate the efficacy of gabapentin for reducing pre-operative anxiety, post-operative pain and opioid consumption. The initial study examined regimens of pre-operative and post-operative gabapentin given to patients undergoing total knee arthroplasty. Patients that received gabapentin postoperatively used significantly less morphine at 24 hrs, 36 hrs and 48 hrs (p<0.05). Furthermore these patients had significantly better active-assisted knee flexion on postoperative day (POD) 2, POD 3, with a trend toward better flexion on POD 4. Next, we examined whether: 1) gabapentin administration reduces pain and opioid use after total hip arthroplasty using a multimodal analgesic regimen that included spinal anesthesia; and whether 2) preoperative administration of gabapentin is more effective than postoperative administration. Our results demonstrated that whether a 600 mg dose of gabapentin was given preoperatively or postoperatively, patients’ postoperative morphine consumption or pain scores were not reduced in hospital nor was there a reduction in pain 6 months after hip arthroplasty. The third study found that a single dose of 600 mg of gabapentin was not sufficient to reduce preoperative anxiety in patients prior to hip arthroplasty. In contrast, the final study demonstrated that 1200mg of gabapentin reduced pre-operative anxiety and pain catastrophizing in female patients with moderate to high levels of preoperative anxiety prior to major surgery, but also increased preoperative and early postoperative sedation. Our findings demonstrate the efficacy of perioperative gabapentin with respect to preoperative anxiety reduction and decreasing morphine consumption after surgery. Future studies that focus on the optimal dose and duration of perioperative gabapentin, with the aim of improving functional outcomes and decreasing the incidence and severity chronic post-surgical pain are warranted.

The aim of this research was to compare the pain experience of cardiac surgical patients who attended the Acute Pain Service (APS) education program with cardiac surgical patients who did not attend the APS. The participants of both groups, pain levels, consumption of total analgesia, anxiety levels, satisfaction with pain management, ratios of self-administered bolus doses and failed attempts on Patient Controlled Analgesia (PCA) device and their length of hospital stay were compared. The findings indicated no statistical significant differences between the two groups being investigated in relation to pain levels, total analgesia consumed, anxiety levels, satisfaction with pain management, total demands and delivery attempts on the PCA and their length of hospital stay. The clinical mplications are significant. The preoperative pain management education program provided by APS clinical nurses for cardiac surgical patients does not have the positive outcomes expected.

Made available in DSpace on 2014-08-13T14:50:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-03-26Bitstream added on 2014-08-13T18:00:43Z : No. of bitstreams: 1 000755533.pdf: 972156 bytes, checksum: c11edf3a07ab6f316ae666f53d237989 (MD5) / Diariamente centenas de mulheres recebem o diagnóstico de câncer de mama. É o maior responsável por mortes relacionadas ao câncer entre as mulheres. O diagnóstico do câncer de mama sofreu grandes mudanças nas últimas décadas. Saímos de um quadro de predomínio absoluto de doença avançada ao diagnóstico para diagnósticos em fases cada vez mais iniciais. Essas mudanças ocorreram graças aos programas de rastreamento mamográficos. Passamos a realizar cada vez mais procedimentos cirúrgicos ambulatoriais com anestesia local, visando diagnóstico do câncer de mama nesta fase inicial, subclínica. Com esta nova realidade, surgem novas preocupações, como a dor e desconforto que podem envolver tais procedimentos. Vários estudos já determinaram preditores que estariam associados a queixa de maior dor no pós-operatório desses procedimentos realizados ambulatorialmente. E no caso da dor intra-operatória? Há fatores pré-operatórios que possam predizer a intensidade da dor referida, no intra-operatório, em pacientes submetidas a procedimento cirúrgico ambulatorial sob anestesia local? Trata-se de um estudo prospectivo, controlado, sem cegamento, realizado no Hospital de Câncer no período de 01/2012 a 01/2013. A coleta dos dados foi realizada por uma única profissional treinada para a aplicação do questionário. As participantes respondiam a um questionário envolvendo dados demográficos, história mórbida pregressa e ansiedade (IDATE - Inventário de Ansiedade Traço-Estado). Ao término do procedimento os cirurgiões e pacientes responderam um questionário com suas percepções sobre o procedimento. Utilizou-se a Escala Visual Analógica (EVA) para quantificação da dor. Considerou-se como dor importante 2 pontos de corte – EVA ≥ 4 e EVA ≥ 7. Foram avaliadas 230 pacientes. Para ponto de corte 4 observa-se maior queixa de dor em pacientes portadores de doença reumatológica ... / Every day hundreds of women are diagnosed with breast cancer. It is largely responsible for cancer-related deaths among women. The diagnosis of breast cancer has undergone major changes in recent decades. We left a picture of absolute predominance of advanced disease at diagnosis for diagnoses in increasingly early stages. These changes occurred due to mammographic screening programs. We come to realize increasingly ambulatory surgical procedures under local anesthesia, aiming diagnosis of breast cancer at this early stage, subclinical. With this new reality, new concerns, such as the pain and discomfort that may involve such procedures. Several studies have determined predictors that were associated with greater complaints of pain postoperatively these procedures performed in an outpatient setting. And in the case of intraoperative pain? Are there preoperative factors that may predict the intensity of referred pain, intraoperatively in patients undergoing ambulatory surgical procedure under local anesthesia? This was a prospective, controlled, without blinding held at Cancer Hospital in the period from 01/2012 to 01/2013. Data collection was performed by a single trained professional to the questionnaire. The participants completed a questionnaire involving demographics, disease history and anxiety (STAI - Trait Anxiety Inventory-State). At the end of the procedure the surgeons and patients completed a questionnaire with yours perceptions about the procedure. We used the Visual Analogue Scale (VAS) for pain assessment. It was considered as significant pain two cutoffs - VAS ≥ 4 and VAS ≥ 7. 230 patients were evaluated. For cutoff 4 shows biggest complaint of pain in patients with rheumatologic disease (p = 0.01), personal history of breast cancer (p = 0.02), patients undergoing excisional biopsies / incisional biopsies compared guided stereotactic (p = 0.05), more anxiety preoperatively ...

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Paclitaxel use in cancer is limited by a painful syndrome characterized by acute and chronic phases and by the lack of efficacious therapies. Thus, we assessed the efficacy of analgesics used in the World Health Organization (WHO) ladder for a cancer pain relief in a model of paclitaxel-induced pain syndrome (P-IPS). Hyperalgesia was measured with von Frey filaments. P-IPS was induced in rats by four injections of paclitaxel on alternate days. The acute and chronic phases were assessed 24 h and 15 days after the first injection, respectively. Rats were treated orally with vehicle, acetaminophen (step 1 of the ladder), codeine alone or plus acetaminophen (step 2) and morphine (step 3) after acute or chronic phases assessment. Acetaminophen, codeine and morphine were equi-efficacious in reversing the acute phase of the P-IPS, but opioids were more potent than acetaminophen. Codeine plus acetaminophen had similar efficacy and potency when administered together, but produced longer-lasting effect. The repeated treatment with paclitaxel also led to a marked hyperalgesia in the chronic phase of the painful syndrome. Acetaminophen, codeine and morphine partially reversed chronic phase of P-IPS, losing their efficacy and, in the case of codeine, potency when compared to acute phase. However, the administration acetaminophen with codeine increased the potency and the efficacy of the opioid, producing a long-lasting anti-hyperalgesic effect. Together, analgesics of WHO ladder are capable of reverting both acute and chronic phases of P-IPS, with codeine plus acetaminophen presenting more potent, efficacious and long-lasting effect. Thus, WHO analgesics ladder could also be useful to treat P-IPS. / O uso do paclitaxel no câncer é limitado por uma síndrome dolorosa caracterizada por uma fase aguda e crônica, e também, pela falta de terapias eficazes para o seu tratamento. Assim, avaliou-se a eficácia dos analgésicos usados na escada da organização mundial da saúde (OMS), utilizada para o alívio da dor do câncer, em um modelo de síndrome dolorosa induzida por paclitaxel (SDIP). A hiperalgesia foi avaliada através de filamentos de von Frey. A síndrome dolorosa foi induzida por quatro injeções de paclitaxel em dias alternados. As fases agudas e crônicas foram avaliadas 24 h e 15 dias após a primeira administração, respectivamente. Os ratos foram tratados por via oral com veículo, paracetamol (degrau 1 da escada), codeína sozinha ou em combinação com paracetamol (degrau 2) e morfina (degrau 3), após a avaliação das fases aguda ou crônica. Paracetamol, codeína e morfina foram equi-eficazes na reversão da fase aguda da SDIP, mas os opióides, foram mais potentes quando comparados ao paracetamol. Codeína mais paracetamol teve eficácia e potência semelhante, quando administrados em conjunto, mas produziu um efeito mais duradouro. A repetição do tratamento com paclitaxel também levou a uma marcada hiperalgesia na fase crônica da síndrome dolorosa. O paracetamol, a codeína e a morfina reverteream parcialmente a hiperalgesia induzida por paclitaxel, perdendo a sua eficácia e, no caso de codeína, a potência quando comparados à fase aguda. No entanto, a administração de codeína com paracetamol aumentou a potência e a eficácia do opióide, produzindo um efeito anti-hiperalgésico mais prolongado.Juntos, os analgésicos da escada são capazes de reverter ambas as fases aguda e crônica da SDIP, sendo que a codeína mais paracetamol apresentou-se mais potente, eficaz promovendo um efeito de longa duração. Assim, os analgésicos escada da OMS podem ser úteis para o tratamento da SDIP.

Made available in DSpace on 2015-01-26T13:21:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-27Bitstream added on 2015-01-26T13:30:20Z : No. of bitstreams: 1 000798948.pdf: 550372 bytes, checksum: f10ce3f3df946e48b55509da0632ec4e (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A dor tem sido historicamente negligenciada em animais e o seu reconhecimento e quantificação ainda são um desafio a ser superado, sobretudo em animais de grande porte. Objetivou-se registrar os comportamentos e definir a validade e confiabilidade de uma escala para avaliar a dor aguda pós-operatória em bovinos. Quarenta bovinos foram submetidos à orquiectomia com sedação e anestesia local. Os animais foram avaliados e filmados, antes e após o procedimento cirúrgico e a partir da análise dos vídeos foi desenvolvido um registro de comportamentos. Adicionalmente foi utilizado um pedômetro adaptado ao membro do animal, para informações do número de passos, tempo em decúbito e número de vezes que entra em decúbito, no sentido de correlacionar ou não com as experiências de dor no período pós-operatório. A escala se baseou em estudos prévios, estudo piloto e análise das filmagens. Avaliaram-se os animais por meio de filmes referentes aos períodos pré-operatório (M1) e pós-operatório, antes (M2) e após analgesia de resgate (M3) e 24 horas após a cirurgia (M4). Três observadores encobertos e um padrão-ouro avaliaram os filmes e estes foram reavaliados um mês após a primeira análise pelos observadores encobertos. Observou-se diferença no número de vezes que entra em decúbito entre 24 horas antes e após o procedimento cirúrgico. O refinamento da escala foi determinado pela validade do critério atestada pela concordância entre os observadores encobertos e o padrão-ouro, de forma que os itens postura em estação e posição da cabeça foram excluídos da escala por não apresentarem concordância satisfatória. Realizou-se a análise fatorial para determinar a dimensionalidade da escala, resultando em uma escala unidimensional. A correlação item-total pelo coeficiente de correlação de Spearman determinou a exclusão do item atenção à ferida cirúrgica. Após o refinamento, a consistência interna foi ... / Pain has been historically neglected in animals and its recognition and quantification remains a challenge to be overcome, especially in large animals. This study aimed to record behaviors and define the validity and reliability of an acute postoperative pain scale in cattle. Forty cattle underwent orchiectomy with sedation and local anesthesia. Animals were evaluated and filmed before and after the surgical procedure. The videos were viewed and behaviors were recorded. Additionally, a pedometer was adapted on the limb of each animal to record the number of steps, time of lying down and number of times to get decubitus. These data were used to correlate or not with the experience of pain in the postoperative period. The scale was based on previous studies, pilot study and video records analysis. Animals were evaluated by movies in preoperative (M1) and postoperatively period, before (M2) and after rescue analgesia (M3) and 24 hours after surgery (M4). Three blinded and one gold standard observers evaluated the movies, which were revalued one month after the first analysis. Difference in the number of times to get decubitus between 24 hours before and after the surgical procedure was detected. The refinement of the scale was determined by criterion validity. This was attested by agreement between each blinded observers and the gold standard, so the items standing posture and head position were excluded for not having satisfactory agreement. Factor analysis determined the dimensionality of the scale, resulting in a unidimensional scale. Item-total correlation by Spearman rank correlation coefficient determined the exclusion of the item attention to surgical wound. After refinement, internal consistency was assessed by calculating the Cronbach α coefficient (α = 0.866) and was considered excellent. UNESP-Botucatu unidimensional pain scale was correlated with visual analogic, descriptive and numerical ... / FAPESP: 11/02472-1