Pain control

Infusion devices have been used for diabetes, cancer chemotherapy, pain control (patient-controUed analgesia, ie, PGA), infection, Alzheimer s disease, Parkinson s, nausea, thalassemia, thromboembolism, and to treat severe spasms resulting from spiaal cord iajury (140—143). 

Adequate pain control (i.e., morphine) and sedative use (i.e., propofol, benzodiazepine)... 

Monitor for adequate pain control and the need for escalation or de-escalation of analgesia. 

Despite the growing emphasis on pain management, pain often remains undertreated and continues to be a problem in hospitals, long-term care facilities, and the community. In one series of reports, 50% of seriously ill hospitalized patients reported pain however, 15% were dissatisfied with pain control, and some remained in pain after hospitalization.14,15... 

BA is a 58-year-old male recently diagnosed with lung cancer. Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 120 mg of morphine/24 hours with adequate pain control. 

Conversion from one dosage form to another or from one opioid to another may be necessary in situations such as ineffective pain control, emergence of side effects, change in patient status, and in formulary restrictions. Equianalgesic doses should be I used when converting from one opioid to another. Clinicians... 

Titrate the dose to one that achieves an adequate level of pain control. 

In patients treated with acetaminophen or NSAIDs, assess pain control after 2 to 3 weeks. It may take longer for the full anti-inflammatory effect of NSAIDs to occur. 

Develop a plan to assess effectiveness of pharmacologic therapy. If pain is from an acute injury, assess effectiveness within 7 to 10 days. For chronic pain treated with capsaicin, begin to assess pain control in 2 weeks. 

Obtain a thorough history of prescription, nonprescription, and natural drug product use. For pain control, determine which treatments have been helpful to the patient in the past. Is the patient currently taking any medications on a chronic basis ... 

Monitor vital signs (i.e., temperature and heart rate) and laboratory assessments (i.e., WBC count) daily to assess resolution of infection and efficacy of pain medications. When possible, interview the patient to obtain additional information about pain control. 

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

D/C offending agents symptomatic management of pancreatits—bowel rest, IV hydration, pain control, gradual resumption of oral intake... 

Pain management is also of critical importance in patients with spinal cord compression. While dexamethasone will provide some benefit, opioid analgesics also should be used and titrated rapidly to achieve adequate pain control. 

Improved pain control using detailed pain assessment every 2 to 4 hours during initial titration and then daily thereafter... 

Antispasmodic agents such as oxybutynin 5 mg by mouth two to three times daily may be used for bladder spasms. In patients with refractory pain, opioid analgesics should be titrated to adequate pain control. 

G. Gourlay and R. Boas, Fatal outcome with use of rectal morphine for postoperative pain control in an infant, Br. Med. J, 304, 766 (1992). 

Percutaneous patches are used in small animals. Fentanyl is a drug used for pain control and is quite effective. Unfortunately, it is quite toxic to animals and young children if accidentally ingested. 

Second, the book includes sections on pain control, antibiotic use in neutropenic fever, antiemetic guidelines, and supportive care medications. The book continues with a section on drugs used in commonly encountered problems in hematology, and concludes with a listing of the wholesale costs of most chemotherapy agents. The rapid growth of chemotherapeutic options will make frequent updates of this handbook essential for the future state-of-the-art care of our patients. 

Low-dose opioids should be used initially, usually in combination with acetaminophen. Sustained-release compounds usually offer better pain control throughout the day and are used when simple opioids are ineffective. 

Tramadol should be initiated at a lower dose (100 mg/day in divided doses) and may be titrated as needed for pain control to a dose of 200 mg/ day. It is available in a combination tablet with acetaminophen and as a sustained-release tablet. 

In patients with mild AP, pain control, fluid and electrolyte status, and nutrition should be assessed periodically depending on the degree of abdominal pain and fluid loss. 

Suspicion of addiction commonly leads to suboptimal pain control. Factors that minimize dependence include aggressive pain control, frequent monitoring, and tapering medication according to response. 

Dementia, migraine, Parkinson s disease, seizures, stroke, neoplasms, poor pain control Respiratory system... 

There are different ways to use exposure with clients. The first method, called in vivo exposure, means that you expose the client under real-life conditions. In vivo exposure allows clients to practice for experiences they will likely face regularly in the real world under the controlled conditions of therapy. Let me present an example of how in vivo exposure would work with a client. Suppose your client has chronic pain and a history of abusing prescription pain-controlling medicines. Chronic pain in this instance represents a cue for drug use. You would most certainly want your client to learn how to confront his or her chronic pain directly without resorting to use of the pain medicines. In vivo cue exposure to pain in session would encourage the client to face his or her pain in real life without responding in the old way. 

Basbaum AI, Fields HL. (1984). Endogenous pain control systems brainstem spinal pathways and endorphin circuitry. Anna Rev Neurosci. 7 309-38. 

Basbaum AI, Fieids HL. (1978). Endogenous pain control mechanisms review and hypothesis. Ann Neurol. 4 451-62. 

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