Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.

There is a large gap between contemporary evidence-based remedies for pain control and what is offered to Ukrainian patients with pain. Having thousands of people needlessly suffer from avoidable pain forces a consideration of 1) what prevents from their access to pain relief, 2) are their human rights being violated and 3) how can the situation be improved. In order to identify the obstacles to adequate pain management in Ukraine I collected evidence using two methods. First, I designed a questionnaire for the Ukrainian doctors, received approval from the University of Ottawa Ethics Board, distributed the questionnaire among potential responders and then organized the obtained results. Second, I did an extensive literature review to provide evidence from the patients. Then I analysed the provisions of Ukrainian domestic and international legislation as well as the available case law to find out if the human rights of Ukrainian patients and doctors are being violated by denial of adequate pain relief. According to my findings, the barriers to pain control in Ukraine are multidimensional and interdependent. They cause violations of human rights, which are not being effectively defended through the courts of Ukraine. These findings call for a more constructive approach to the development of the Ukrainian health law and policy, which I offer in this thesis.

This randomized, double-blind, placebo-controlled study was conducted to compare the effectiveness of intravenous acetaminophen vs. oral acetaminophen or placebo as an adjunct to opioids on lowering post-operative pain scores, discharge time, need for opioids, and opioid-related side effects, as well as assessing for any effects pain treatment has on embryological and pregnancy outcomes. Secondary analysis included identifying risk factors in patients that cause them to have worsening pain or minor relief from traditional pain management. This study was conducted at a single academic fertility center at Massachusetts General Hospital in Boston with a patient population of 159 English-speaking women between 18-43 years old, undergoing oocyte retrieval as a part of In Vitro Fertilization procedure. Participants were randomly placed in one of three treatment groups to receive either 1000mg IV acetaminophen and PO placebo (Group A), IV placebo, and 1000mg PO acetaminophen (Group B), or IV and PO placebo (Group C) as pain control before oocyte retrieval procedure. The primary outcomes measured were patient-reported post-operative visual analogue scale pain scores in the recovery room at 10 minutes, 30 minutes, and discharge time. Using these values to measure the effectiveness of each treatment at improving post-operative pain. To assess the relationship, if any, between demographical or clinical factors and pain, we analyzed what factors were common in those experiencing high or low pain. We used the Visual Analog Scale (VAS) which has patients rank pain from 1-10. For this analysis, low pain is defined as those whose 10-minute post-operative pain score was less than 5 (VAS score <5/10) and high pain as those whose 10-minute postoperative pain score is 5 or greater (VAS score 5+/10). Results showed that mean post-operative pain scores were similar between the study groups at 10 minutes (A:2.3, B: 2.6, C:2.8, p=0.51). Timing of discharge was also similar (A:60.1 mins, B: 58.8 mins, C:57.6mins; p=0.76). Although not statistically significant, the mean post-operative opioid dose for patients in group A was less than half of that in Group B and C (0.24mg vs. 0.59mg vs. 0.58mg; p=0.34) and fewer required rescue pain medication in the recovery room (4% vs. 19% vs. 15% respectively; p=0.24). There was a trend towards decreased side effects of constipation in Group A compared to Groups B and C (15% vs. 31% vs. 33%, respectively; p=0.07). There were no differences in embryological or early pregnancy outcomes between study groups. An analysis of predictors of pain, patients with BMI >/=30kg/m2 (obese) were more likely to report high post-operative pain (p=0.009). Prior abdominal surgeries, including pelvic laparoscopy and laparotomy, were associated with low post-operative pain (p=0.069 and p=0.025, respectively). Those who reported having pre-operative pain greater than zero were more likely to report lower postoperative pain (p=0.002). There was no significant relationship between race/ethnicity, infertility diagnosis, and procedure length and pain. This study's findings showed no significant difference between post-operative pain scores or discharge times in women undergoing oocyte retrieval when given IV acetaminophen, PO acetaminophen, or a placebo. There were severe findings that suggested that IV acetaminophen may reduce the need for post-operative narcotics and lead to fewer opioid-related side effects, however these findings while large were statistically insignificant. The predictors of higher post-operative pain we found, including high BMI, no prior history of abdominal procedures, and lack of pre-operative pain, indicate that further investigation into these predictors could be beneficial. This information may allow physicians and anesthesiologists to optimize their pain control.

Background Pain during birth process is acknowledged for good progress of labour but severe, unbearable pain cause reduced effectiveness of contractions and lead to maternal exhaustion and fetal distress. Non pharmacological and pharmacological pain relief methods can be implemented to assist the women to cope with pain during labour. Non-pharmacological and pharmacological pain relief is available in the hospital, but it is not understood when and how labour pain is assessed and pain relief implemented. Research questions What is the current workplace culture relating to pain management during the first stage of labour? What alternative strategies can be implemented to address the current workplace culture relating to pain management during the first stage of labour? Research design and methods A qualitative design was followed. Convenience sampling was used and 18 observations on pain management during labour were done. Midwives taking care of women during labour took part in the research and their informed consent was obtained beforehand. Data was collected during unstructured observations of pain management during labour. Data was analysed by means of the creative hermeneutic data analysis method. Main findings Four themes were derived from the data: pain assessment, isolation, therapeutic environment and documentation. Based on these themes, strategies for improving pain management during labour were identified collaboratively. / Dissertation (MCur)--University of Pretoria, 2017. / Nursing Science / PhD / Unrestricted

Unmanaged pain is a widespread problem that many cancer patients face on a daily basis. Cancer pain, which can either be caused by complications due to the disease process itself or from treatment measures used, has devastating effects on the quality of life for these patients and their caregivers. This study examined the knowledge and attitudes of undergraduate students regarding pain management. The sample in this study consisted of 41 undergraduate students at the University of South Florida College of Nursing. The students sampled were predominantly white, (n=30), female (n=37), seniors (n=41) taking Leadership and Management in Nursing. After volunteering to participate, students completed the demographic data form, the nurses' attitude survey and the Pain Management Principles Assessment Tool. The mean age of students was 22.46 years, with a range from 18 to 42 years. One student indicated that he or she had a bachelor's degree in another field with the majority of students being first time college students (n=31). The results of the study showed that a mean score of 19.4 (SD= 3.0) out of a possible 31(63%) was achieved on the knowledge of the students regarding pain management while, a mean score of 17.0 (SD=2.6) out of 25 (68%) was achieved on the Nurses' Attitude Survey. The data showed that nursing students demonstrated inadequate knowledge regarding pain management, and had mixed attitudes towards pain management. However, a weak to moderate relationship between knowledge and attitudes was found (r=0.33, p=0.038) due to the fact that students lacked the fundamental knowledge, and understanding as to why they were practicing certain pain management skills. Although the sample size was relatively small and not ethnically or demographically diverse, the response from the sample was sufficient in providing statistically meaningful data for this study. The results were seen to be consistent with previous studies that show poor management of pain. The findings of this study suggest the need for the development of specific strategies to effectively teach students about pain management, as well as integrate pain management as a major component of the undergraduate-nursing curriculum to improve patient outcomes.

Background: Multimodal analgesia in rib fractures (RFs) is designed to maximize pain control while minimizing narcotics. Prior research with intravenous lidocaine (IVL) efficacy produced conflicting results. We hypothesized IVL infusion reduces opioid utilization and pain scores. Methods: A retrospective review of RF patients at an ACS-verified Level I trauma center from April 2018 to 2/2020 was conducted. Patients (pts) stratified as receiving IVL vs no IVL. Initial lidocaine dose: 1 mg/kg/hr with a maximum of 3 mg/kg/hr. Duration of infusion: 48 h. Pain quantified by the Stanford Pain Score system (PS). Bivariate and multivariate analyses of variables were performed on SPSS, version 21 (IBM Corp). Results: 414 pts met inclusion criteria: 254 males and 160 females. The average age for the non-IVL = 67.4 ± 15.2 years vs IVL = 58.3 ± 17.1 years (P <.001). There were no statistically significant differences between groups for ISS, PS for initial 48 h, and ICU length of stay (LOS). There was a difference in morphine equivalents per hour: non-IVL = 1.25 vs IVL = 1.72 (P =.004) and LOS non-IVL = 10.2+/−7.6 vs IVL = 7.82+/−4.94. By analyzing IVL pts in a crossover comparison before and after IVL, there was reduction in opiates: 3.01 vs 1.72 (P <.001) and PS: 7.0 vs 4.9 (P <.001). Stanford Pain Score system reduction in the IVL = 48.3 ± 23.9%, but less effective in narcotic dependency (27 ± 22.9%, P =.035); IVL pts had hospital cost reduction: $82,927 vs $118,202 (P <.01). Discussion: In a crossover analysis, IVL is effective for reduction of PS and opiate use and reduces hospital LOS and costs. Patient age may confound interpretation of results. Our data support IVL use in multimodal pain regimens. Future prospective study is warranted.

Chronic pain syndrome continues to be a national health concern among all medical specialties. It has an impact on the entire health care system and if current trends continue, the economic impact alone will exceed 100 billion dollars. In 2014, 254 million prescription opioids were written in the United States. During this time, an increase in prescription opioid related deaths was seen, with approximately 20,101 deaths occurring in 2015. Properly trained clinicians across the health care system are needed to achieve successful patient outcomes, while reducing cost, morbidity, and mortality. The purpose of the scholarly project was to develop a comprehensive, opioid-specific, expert reviewed and evidenced-based educational module for health care clinicians of all specialties. Using the guidelines offered by the Center for Disease Control in 2016, the content of the project was developed with a primary focus on the clinical processes, pharmacological properties, and appropriateness of opioids in the treatment of chronic pain. The educational module was disseminated to 10 experts in the field of pain management and family practice. Each of them was asked to evaluate the educational module and evaluate it from an expert standpoint via Likert-scale evaluation form. The data revealed a median score of 4.5 out of 5 for most all categories, demonstrating the project's ease of use, evidenced-based content, and its ability to further expand the knowledge of clinicians. The project will be presented to stakeholders and state representatives for wide spread distribution. Educating health care professional over the continuum will ensure effective social change and shift the current trends in prescription opioid related mortality and morbidity.

Background: In the sub-Saharan African countries, cancer pain is a widespread and intractable problem that has a major impact on the quality of life of patients with cancer and their relatives. For many patients, cancer causes a series of symptoms, where pain is one of those that, according to research, affects the patient negatively in several ways. Purpose: The purpose of the literature review was to compile literature on pain in patients with cancer in sub-Saharan Africa. Method: A general literature study based on a systematic method of analyzing data (Popenoe et al., 2021). Searches have taken place in databases of scientific articles and 13 articles with a qualitative, quantitative and banded design have been included.   Results: A compilation of the results yielded four themes: Occurrence of pain, Pain assessment instruments, Medicines, CAM and alternative treatment methods and Impact on daily life. The studies show that patients with cancer report a lot of pain and that assessment tools are used very rarely. In addition to this, drugs for pain are difficult to obtain. Alternative treatment methods are common and pain is strongly associated with anxiety, depression and negative impact on quality of life.   Conclusion: Patients with cancer in sub-Saharan Africa report a lot of pain, which has a major impact on daily life. A number of obstacles to optimal pain relief have been identified and several studies have been conducted on these obstacles. Solutions exist, but the process is complicated by laws, financial priorities, the ignorance of the healthcare staff and availability of pain medication. Education of healthcare professionals, overview of laws and local regulations and increased availability of pain medication can improve the pain problem and increase the quality of life for patients with cancer in sub-Saharan Africa.

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