The role of patient-controlled analgesia in the management of chronic pain (original) (raw)
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Patient Controlled Analgesia (PCA) A new PCA system
Patient Controlled Analgesia (PCA) allows the patient to administer his own pain relief via a computer controlled infusion pump. When the patient feels pain he presses a button and a strong pain medication (analgesic, such as Morphine) is infused directly into the bloodstream. The response is fast. Figure 1 Figure 1 A simple PCA system: The patient presses a button on the handset and receives pain medication intravenously. This system is used for EXTREME pain, for people after surgery or major trauma. Most patients do not obtain enough pain relief with the current models because: The amounts of pain medication are fixed at a low 'safe' level. The amount of pain medication required varies up to 20 times between patients. A new PCA system, called the "Adaptive PCA" has been developed and trialed on 21 patients at the Royal Melbourne Hospital.
Management of chronic non-cancer pain: a framework
Pain Management
Aim: Since publication of the CDC 2016 Guideline, opioid-related mortality in the USA has doubled and a crisis has developed among the 15–20 million Americans with chronic, moderate-to-severe, noncancer pain. Our aim was to develop a comprehensive alternative approach to management of chronic pain. Methods: Analytic review of the clinical literature. Results: Published science provides a solid framework for the management of chronic non-cancer pain, detailed here, even as it leaves many knowledge gaps, which we fill with insights from clinical experience. Conclusion: There is a sufficient basis in science and in clinical experience to achieve adequate control of chronic pain in nearly all patients in a way that adequately balances benefits and potential harms.
The role of patient-controlled analgesia in the management of cancer pain
Journal of Pain and Symptom Management, 1992
The technology of patient-controlled analgesia (PCA) has gained wide acceptance for use in cancer pain management. Assessment of technological innovations is necessary in order to evaluate the most appropriate use fiom the perspective of the individual patient and broader health policy perspective. This paper reviews the literature related to PCA use in chronic cancer pain, appropriate and inappropriate uses of PGA, as well as several professional issues and directions for future PCA use. Professional dialogue regarding the standard of PCA care is necessaly for optimum use of this technology for relief of chronic pain.J Pain Symptom Manage 1992; 7:149-154.
Postoperative patient-controlled analgesia (PCA): How much control and How much analgesia?
2003
Postoperative patients received one of the three, alternative pain-management treatments: patient-controlled analgesia (PCA); perceived PCA (PPCA without actual control) and continuous intravenous infusion of analgesics (CII). Pain reports, morphine consumption and satisfaction of the groups were compared, and influences of individual differences in preferences for control and trait anxiety were tested. The main findings were: (1) PCA patients consumed less morphine and reported more pain and somewhat higher satisfaction;
2013
"Pain can cause significant suffering and may impact every facet of the patient. Not only is there a clear underlying physical component to the pain, but there is also a mental element that can impact all psychosocial components of the patient’s life. Untreated pain can lead to long-term negative effects in patients of all ages, with a link to increased utilization of the healthcare system, an increase in morbidity and mortality, the development of hyperalgesia and impaired normal development. (1,2) Therefore, in order to minimize short- and long-term negative outcomes, it is essential to recognize and treat pain as soon as it occurs, as well as to select the most appropriate pain medication based on patient-specific factors. Pharmacists can contribute significantly to helping patients achieve these important goals, in collaboration with the members of the health care team, first and foremost being dialogue with the patient and/or their family. Pain Exposure Pain assessment is a crucial component in the quality of patient care and is the first step to effective pain management. Pain can be measured using a self-report, behavioural, or physiological approach. (3) The self-report approach involves understanding the patient’s subjective experience, which may not be directly visible to the health care provider (HCP). This approach takes the patient’s own assessment of feelings, images, or statements about their pain as they experience it. (3) The behavioural approach involves observing the patient for any physical or mental distress. (3) Lastly, the physiological approach examines how the patient’s body reacts when it is in pain. (3) In addition to these three pain assessment approaches, the following dimensions must also be considered: type of pain, onset and frequency of pain, location (including radiation), intensity at rest and activity, quality, associated symptoms, temporal or seasonal variations, impact on daily living, factors that precipitate and/or aggravate the pain, factors that relieve pain, and culture, ethnic or religious background. (3) The above considerations are essential components of pain assessment because there is currently no objective way to measure a patient’s pain. The sensation of pain is subjective and the existence of pain cannot be proved or disproved. There are assessment techniques that can be used to help HCPs understand the patient’s current pain situation. The current gold standard of pain measurement is the self-reporting approach using various types of scales. (3) A nationally accepted scale is the numerical rating scale, which is based on pain intensity. (3) This assessment tool is a 10-point pain assessment scale, where 0 is no pain and 10 is the worst pain imaginable. The rating given by the patient depends on the observer, which requires a subjective report from the patient but also an objective observation by the health care provider" Lamoure J, Stovel J, Sanghera N. Optimizing Pain Management. Pharmacy Practice 2013 June: 29 (3); pp. 16-20,27-28"
Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain
Pharmaceutics
Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient’s life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guideli...
Analgesic-Dosing-Behaviours-In-Patients-With-Chronic-Non-Cancer-Pain-Does-It-Affect-The-Pain-Control
Malaysian Journal of Pharmacy, 2021
Chronic pain has a significant impact on sufferers' quality of life. Furthermore, treatment inadequacies are often reported in the literatures. This study aims to investigate the prevalence of the different dosing behaviors in analgesics use in chronic, non-cancer pain and their correlation to pain control. This is a cross-sectional study and a convenience sampling method was applied. Brief Pain Inventory-Short Form and Pain Management Index was computed to assess pain control. Statistical analysis was performed with Pearson chi-square test and alpha value was set at 0.05. A total of 127 patients were analyzed. 70.9% of the patients reported inadequate pain control with their prescribed analgesic(s). 88.2% patients only took oral analgesics whenever they felt the pain while 11.8% patients took around-the-clock despite the absence of pain. Among them, 11.8-34.7% of patients did not follow their prescriber's instruction for oral and topical analgesic use respectively. However, no statistically significant result was found between the dosing behaviors and pain control (p>0.95). It was also reported that 98% of patients were not aware of the maximum daily dose of their prescribed analgesic(s). The prevalence of 'as needed' dosing is higher than around-the-clock dosing in the management of chronic, non-cancer pain, with deviation from the prescribed instructions between 11.8-34.7%. However, those differences were not significantly associated with the pain control.