Purpose: This thesis addresses feasibility issues of conducting a descriptive study of pain and health-related quality of life (HRQOL) in women after Cesarean section (c-section). Objectives: Feasibility issues surrounding population access, chart completeness for review, and preference for online data collection were investigated. Prevalence and prediction of postoperative pain and HRQOL at six-weeks was addressed to generate hypotheses for future study. Methods: A descriptive pilot design was used, collecting a convenience sample of 41 women recruited two hours prior to a planned c-section at Kingston General Hospital. Consenting women completed preoperative questionnaires via computerized tablet or paper and pen. Preoperative data included pain, HRQOL, anxiety, depression, somatization, HCU, and demographics. Six weeks postoperatively, women completed pain, HRQOL, and HCU questionnaires through the internet, postal mail, or telephone. A chart review was used to collect health and obstetrical history, and acute postoperative pain. Results: An average of two participants per week were recruited, with a participation rate of 83.7%. Online questionnaires were preferred by 34 women (83%) preoperatively, and 15 women (48.4%) postoperatively. Almost 40% of patient charts were incomplete, missing symptoms reported in the immediate postoperative period. Twenty-four percent of the sample was lost to follow-up. Mild postoperative pain was reported by seven women (23) within 24 hours of completing the questionnaire. Bodily pain and the physical component of HRQOL were worse both pre- and post-operatively than age- and sex-matched norms. Postoperative pain at six weeks was predicted by tubal ligation, pain expectancy, and severe postoperative acute pain. Postoperative HRQOL scores were correlated with preoperative HRQOL score, depression, somatization, and preoperative pain. HRQOL physical composite score, bodily pain scores, and trait anxiety were predictive of healthcare use. Conclusion: The planned c-section population is accessible for research purposes, however timing and mode of follow-up should be carefully considered due to the demands of newborn care. A larger study evaluating the prevalence of chronic pain after c-section is needed, in which the role of depression, anxiety, somatization, and pain expectancy in pain outcomes and the impact on healthcare use is investigated. / Thesis (Master, Nursing) -- Queen's University, 2007-10-01 13:12:33.096

This study examines the influence of an educational program on the nursing assessment and management of post-operative pain. A problem-based retrospective audit was implemented to initially determine the nursing assessment and management of post-operative pain. Based on the results of the audit, educational strategies were implemented and a re-audit was carried out to evaluate the changes in nursing practice. There was evidence in the study to support the notion that nurses do not assess or manage post-operative pain effectively. The study suggested that an educational program based on the results of the problem-based audit may improve the frequency and accuracy of documentation of the assessment of pain and the documentation of the utilization of a variety of alternate approaches to relieve post-operative pain. However, the results also indicated that an educational program may not increase the frequency and dosage of analgesic administration and that nurses' perception of their nursing practice may be inconsistent with their actual practice. The study also indicated that nurses will attend educational programs if given the opportunity to participate in the development of these programs. Further studies should be carried out to examine the relationship between written documentation of assessment and management of pain and the actual assessment and management of pain by nurses, between nurses' perceptions of their clinical practice and their actual practice, and among variables environment which may affect nurses' clinical performance. Further studies should also be undertaken to determine if practice-based education programs can influence nurses' clinical practice. / Thesis / Master of Science (Teaching)

Purpose: The purpose of this pilot study was to determine if there is a difference in post-operative pain experience for children following dental restorations and/or extractions under general anesthesia (GA), with and without local anesthetic (LA). The alternative hypothesis is that children will experience less post-operative discomfort and soft tissue trauma when using intra-ligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria, children age 2-6 years requiring general anesthesia for dental treatment. Patients were randomized into categories of either receiving a standardized local anesthetic or no local anesthetic for the dental procedure. A Wong-Baker Faces Pain Scale (Figure 1) was utilized to evaluate pre-operative and post-operative pain. Data were compared using a pooled t-test and two way mixed model ANOVA controlling for sex, ethnicity, and intra-op meds given. Results: Currently, 33 patients have been enrolled in the study. No difference was found in the LA versus the no LA groups, and significantly more pain was reported in the extraction versus non-extraction groups. With the limited sample size, current trends indicate that pain scores do depend on whether or not treatment included the extraction of a tooth. Conclusion: When adequately powered (n=100), this study could assist clinicians providing dental surgeries under general anesthesia care by providing evidence based criteria for the provision of local anesthetic during general anesthesia to reduce need for intra-operative pain medication to relieve post-operative pain.

<p>Patients that have been undergoing surgery often experience pain and anxiety. Pain relief can be problematic because of the side effects and complications that may occur. This leads to a prolonged recovery phase. Music therapy has long been used as an alternative treatment, it is useful from an economic point of view and no side effects have emerged. However, few studies conducted to evaluate its clinical efficacy. The purpose of this literature study was to describe if music as a complementary treatment method can alleviate post-operative pain, anxiety and if any physiological effects occur in the patient. Literature search was performed in the databases Cinahl, Pubmed, Psychinfo and the search base Elin@Kalmar. The main result showed that the postoperative pain decreased in eight scientific articles and anxiety in four of the scientific articles. In two articles, results showed that there were no improvement in pain and cause for anxiety on the scale of patients. Some of the articles also examined whether the alternative treatment had any effect on the patient's vital signs such as heart rate and respiratory values. The results were varied, indicating that further research is needed for an efficient evaluation. The authors believe that music therapy is an appropriate alternative treatment which can relieve post-operative pain and anxiety. Music therapy is also seen as a simple, contact-building and cost-effective method in daily nursing work.</p>

Patients that have been undergoing surgery often experience pain and anxiety. Pain relief can be problematic because of the side effects and complications that may occur. This leads to a prolonged recovery phase. Music therapy has long been used as an alternative treatment, it is useful from an economic point of view and no side effects have emerged. However, few studies conducted to evaluate its clinical efficacy. The purpose of this literature study was to describe if music as a complementary treatment method can alleviate post-operative pain, anxiety and if any physiological effects occur in the patient. Literature search was performed in the databases Cinahl, Pubmed, Psychinfo and the search base Elin@Kalmar. The main result showed that the postoperative pain decreased in eight scientific articles and anxiety in four of the scientific articles. In two articles, results showed that there were no improvement in pain and cause for anxiety on the scale of patients. Some of the articles also examined whether the alternative treatment had any effect on the patient's vital signs such as heart rate and respiratory values. The results were varied, indicating that further research is needed for an efficient evaluation. The authors believe that music therapy is an appropriate alternative treatment which can relieve post-operative pain and anxiety. Music therapy is also seen as a simple, contact-building and cost-effective method in daily nursing work.

Even today, with modern medicine and technology, post-operative pain still exists as anmajor issue in modern treatment. A lot of research efforts have been made, in order toimprove pain outcome for patients that has undergone surgery[18][15].Even though physician's and doctors are well educated, the success rate is aboutapproximately 70 %, still there are patients that experience severe pain, after they haveundergone surgery. There could be several reasons to this, for example, lack of methods orsupport should be amongst other things, factors to consider[18].The problem has been to initiate a case-library and eventually create a tool, that could aidphycisians or doctors in their decision making, which hopefully would help in improvingpain outcome. The chosen method to do this, is a modified version of the CBR-algorithm,which is an artificial intelligence algorithm. The CBR-algorithm makes use of features,solution and outcome, and is implemented with a simple prototype, as a similarity function.The are several reasons for why this method was chosen, but using this method makes itpossible to easily create a web-based tool, so it can easily be accessed from anywhere, butstill be effective and work as a support tool.The algorithm works as a self learning mechanism, and is easy to implement, and theinterface has been constructed, allowing the phycisian or doctor to retrieve informationabout patients and run CBR. The desired results are as expected, it's possible to run theCBR, retrieve and compare cases, and get suggestion of solution or action that should beperformed.The conclusion that can be made, is that, although this is a very basic working medicalapplication, still an overall improvement is needed in order to be used as a medicalapplication. It's anyhow a start. For more details and information, check the appendicesplease. / The PainOut Project

Bibliography: pages 113-118. / This study aims to investigate the use of hospitalized children's free drawings to assess the presence of post-operative pain in patients where language barriers previously prevented the use of existing pain assessment methods. This research involved 50 children ages 6 - 13 years, mostly from impoverished families, treated at the Red Cross Children's Hospital. The design is exploratory-descriptive in nature. The methodology was to collect drawings (110) on admission, after surgery (described as minor to moderate), when the children were expected to be experiencing pain, and also on discharge from hospital. These drawings were compared for picture content and children's responses to a combination of two scales developed and tested elsewhere (Word Graphic Scale and the Pain Ladder Scale), in an attempt to devise an alternative route to gauge subjective pain through drawings. Parental (44) and respondent (6) interviews provided information on parental reaction to children when in pain, and patient pain behaviour. Evidence suggests that children's free drawings can be successfully used in assessing the presence of pain but not the intensity thereof, and are recommended for use in the treatment process.

Bakgrund: Smärtan är subjektiv och det innebär att det är en individuell upplevelse. Den kan upplevas olika beroende på vilka tidigare erfarenheter patienterna har. Ingen annan än patienterna själva kan beskriva den upplevda smärtan. Det är viktigt att patienternas upplevelse av smärta uppmärksammas för att sjuksköterskor ska kunna bemöta deras behov på bästa sätt och därmed minska lidande. Syfte: Syftet var att belysa patienternas upplevelser av postoperativ smärta. Metod: Studien är en litteraturöversikt som är baserad på både kvalitativa och kvantitativa artiklar. Resultat: Resultatet redovisas i fyra olika teman: Att lida av smärta, Betydelse av information och rädsla för läkemedelsberoende, Att vara osäker och inte vilja vara till besvär, Osäkerhet inför framtiden. Smärta är en individuell upplevelse och den postoperativa smärtan kan innebära ett lidande för patienten. De upplever inte alltid att sjuksköterskorna respekterar deras uttryck för smärta och känner sig bortglömda då de saknar att få ta del av information kring framtiden. Slutsats: Det är viktigt för patienterna att få vara involverade i sin vård, smärtlindring och att få tydlig information om vad som berör den postoperativa vården. De behöver stöttning av anhöriga men framförallt av sjuksköterskorna för att kunna lindra både psykiskt och fysiskt lidande. / Background: Pain is subjective and it means that it is an individual experience. It may feel different depending on the previous experience of the patient. No one other than the patient himself can describe the perceived pain. It is important that patients' experience of pain observed for nurses to be able to respond to their needs in the best way and thus reduce suffering. Purpose: The aim is to highlight patients' experience of postoperative pain. Method: The study is a literature review which is based on both qualitative and quantitative articles. Results: The results are reported in four different themes: To suffer from pain, Importance of information and fear of drug dependence, being worried and do not want to be a bother, to feel insecure in front of the future. Pain is an individual experience and postoperative pain may cause suffering for the patient. They do not always experience that nurses respect their expressions of pain and therefore feel forgotten because of their lack of access to information about the future. Conclusion: It is important for patients to be involved in their care, to receive pain relief and to get clear information about what affects the postoperative care. They need support from relatives but especially from all the nurses to decrease both mental and physical suffering.

Orientador: Eduardo Dias de Andrade / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-24T14:46:30Z (GMT). No. of bitstreams: 1 Mello_PaulaSampaiode_M.pdf: 885760 bytes, checksum: 88e6b3366a8005670f894bb45e4a4978 (MD5) Previous issue date: 2014 / Resumo: Analgesia preemptiva é um regime analgésico instituído antes da lesão tecidual, porém sua eficácia na clínica endodôntica ainda é controversa. Este estudo avaliou se a dexametasona e o ibuprofeno promovem analgesia preemptiva em tratamentos ou retratamentos endodônticos, se comparados a um placebo, quando empregada a técnica de instrumentação do sistema de canais radiculares em que se trabalha 1 mm além do comprimento real do dente (ampliação foraminal). Para tal, 97 sujeitos foram divididos aleatoriamente em três grupos e tratados com dose única de 4 mg de dexametasona ou 600 mg de ibuprofeno ou placebo, via oral, 30 minutos antes da intervenção, de forma duplo cega. Ao fim do procedimento, os voluntários foram orientados a fazer uso de uma medicação analgésica de resgate (paracetamol 750 mg), somente em caso de dor. Foi anotado o período de tempo decorrido desde o final da intervenção até a tomada do primeiro comprimido de analgésico, além do consumo total desta medicação no período pós-operatório. A incidência e intensidade de dor foram avaliadas por meio de duas escalas analógicas, descritiva e numérica, preenchidas nos tempos de 4, 6 e 24 horas pós-operatórias. O período de tempo decorrido para a tomada do primeiro comprimido analgésico foi menor no grupo placebo (p<0,0001; teste de Kruskal-Wallis), enquanto que o consumo de comprimidos no período pós-operatório foi maior (p<0,0001; teste de Kruskal-Wallis). Com relação a estes mesmos parâmetros, não foram encontradas diferenças estatisticamente significantes entre os grupos tratados com a dexametasona ou ibuprofeno. Por sua vez, estes medicamentos promoveram uma redução significativa da dor pós-operatória nos tempos de 4 e 6 horas. Considerando a escala analógica descritiva, houve uma menor proporção de indivíduos com dor (leve e moderada) nos grupos tratados, em comparação ao grupo placebo. De acordo com a escala analógica numérica, também promoveram menores valores que o placebo. Não foi encontrada nenhuma diferença estatisticamente significante entre os três grupos após 24 horas, em nenhuma das duas escalas avaliadas. Conclui-se que a dexametasona e o ibuprofeno promovem analgesia preemptiva, reduzem a incidência de dor e a necessidade do uso de analgésicos após tratamentos e retratamentos endodônticos de elementos dentários assintomáticos, quando empregada a técnica de instrumentação do sistema de canais radiculares por meio de patência e ampliação dos forames apicais / Abstract: Preemptive analgesia is an analgesic regimen initiated before the onset of tissue trauma, however its efficacy on endodontic clinic is still controversial. This work evaluated whether dexamethasone and ibuprophen promote preemptive analgesia on endodontic treatments and retreatments, when compared to a placebo, when the radicular canals system instrumentation technique is employed, working 1mm beyond the real tooth length (foraminal enlargement). For this matter, 97 subjects were randomly divided into three groups and treated with a single dose of 4 mg of dexamethasone or 600 mg of ibuprofen or placebo, orally, 30 minutes before intervention, double-blinded. By the end of the procedure, volunteers were oriented to use a rescue analgesic medication (paracetamol 750 mg), only in case of pain. Notes were taken of the time period from the end of the intervention to the moment when the first pill was taken and also of the amount of medication taken during the post-operative period. The pain incidence and intensity were evaluated through two analog scales, descriptive and numerical, which were filled 4, 6 and 24 hours after the intervention. The time period until the first analgesic pill was taken was shorter for the placebo group (p<0,0001; Kruskal-Wallis test), while the consume of pills in the post-operative period was greater (p<0,0001; Kruskal-Wallis test). Considering these same parameters, no statistically significant differences were found among the groups that were treated with dexamethasone or ibuprofen. Nevertheless, these medications promoted a significant reduction of the post-operative pain after 4 and 6 hours. Considering the descriptive analogue scale, there has been a smaller proportion of patients with pain (either mild or moderate) in the groups that were treated, when comparing to the placebo group. According to the numerical analogue scale, they also promoted smaller values than the placebo. No statistically significant difference was found among the three groups after 24 hours, in any of the two evaluated scales. It may then be concluded that dexamethasone and ibuprofen promote preemptive analgesia, reduce the incidence of pain and the need of using analgesics after endodontic treatments and retreatments of the asymptomatic dental elements, when the radicular canal system instrumentation technique is employed through patency and enlargement of the apical foramens / Mestrado / Farmacologia, Anestesiologia e Terapeutica / Mestra em Odontologia

Hypersensitivity after tissue injury is an expression of neuronal plasticity in the central nervous system. This has been explored most extensively using in vitro preparations and animal models of inflammatory pain and chemical irritation. For pain after surgery, a similar process has been proposed. In the present study, we examined dorsal horn neuron (DHN) sensitization using the plantar incision model for post-operative pain. In behavioral experiments, the effect of a local anesthetic injection (or saline vehicle) 15min before plantar incision on pain behaviors several days after incision was studied. Bupivacaine injection before incision prevented pain behaviors until 4h afterwards; injection after incision produced the same effect. One day after incision, pain behaviors were not different between rats injected with saline or bupivacaine. In neurophysiologic experiments, however, bupivacaine injection blocked activation of DHNs during incision. One hour after incision, expansion of receptive fields (RFs) to pinch and increased background activity occurred in 14 of 16 neurons in the saline group but only in two of 22 neurons in the bupivacaine group. The difference was not due to a systemic effect of bupivacaine. Ten sensitized neurons were studied using the injection of bupivacaine 90min after incision. Increased background activity (n=7) and expanded RFs (n=7) were reversed by bupivacaine. Sensitization was re-established in seven of eight neurons 2h after injection as the local anesthetic dissipated. These results indicate that activation of DHNs during plantar incision and sensitization 1h later are not necessary for subsequent pain behaviors. Because sensitization was reversed 90min after plantar incision and then re-established as the local anesthetic effect diminished, enhanced responsiveness of DHN requires ongoing afferent input during the first day after incision.