| 1. |
- Miclescu, Adriana, 1958-, et al.
(författare)
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Changing face of acute pain services
- 2016
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Konferensbidrag (refereegranskat)abstract
- AbstractAims To distinguish the risk factors associated with uncontrolled and problematic pain by prospectively assessing the current acute pain service (APS) activity in an academic hospital and the effects of this activity on both surgical and medical pain intensity.Method This prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before and after treatment. The patients were visited by APS at regular intervals and divided after the number of visits by APS team in several groups: group 1 (one visit and up to 2 follow ups); group 2 (3 to 4 follow-ups); group 3 (5 to 10 times follow-ups); group 4 (10 to 20 follow-ups); group 5 more than 20 follow–ups. The groups and the difference between groups were analyzed.Results Patients (n=730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P=0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 3.4–5.3) to 6.3 (1.0–2.0) for the severe pain (p<0.0001), from 3.8 (3.1–3.8) to 2.4 (2.2–2.4) for the mild pain. Respiratory depression related to pain treatment was reported in 1.6% patients. The APS treated cognitive deficits related to pain treatment, in 30% of the patients, recognized and treated opioid overdose in 14%. The patients who required more than 5 visits by the APS (280 patients representing 38% of all the patients) demonstrated an increased prevalence of psychiatric diseases (from 10% in group 1 to 42% in group 5), opioid dependency (13% in group 1 to 100% in group 5) and chronic pain resulted from both nociceptive (gradually increasing from 38% in group 1 to 85% in group 5) and neuropathic pain (from 13 % in group 1 increasing to 35% in group 5). The diagnoses encountered in the patients with frequent visits by the APS team were cancer related pain (17%), endometriosis (9%), reoperation (12%), burn injury (5%).Conclusions Beside the benefits of APS in reducing of pain intensity, and in treating analgesia side effects, this study demonstrates the uncertain role of APS in the treatment of acute pain. The focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients who suffered adverse effects from pain treatment and have a high of comorbidities as psychiatric diseases, opioid dependency and non-surgical chronic pain.Keywords: acute pain services, complications of pain treatment, opioid induced respiratory depression
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| 2. |
- Miclescu, Adriana, et al.
(författare)
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Persistent neuropathic pain after nerve suture surgery
- 2016
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Ingår i: 16Th World Congress of Pain IASP26-29 Th September Yokohama, Japan.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim of Investigation: Iatrogenic nerve injury has been proposed as the main factor responsable for long term-postsurgical pain. The prevalence of chronic neuropathic pain after a known somatosensory lesion in the upper extremity nerves followed by suture surgery was determined.Methods:The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale questionnaires were sent out in January 2016 to 1078 patients who underwent nerve repairs operations after traumatic or surgical nerve injuries of the upper limbs between 2006 to 2014 at the Hand Surgery Clinic.Results: Three hundred eighty-two patients returned the questionnaire (response rate 35%). Post trauma or post-surgical pain was present in 186 patients (48 %) from those 382 patients who responded to the questionnaire. A total of 87 patients (47 %) of these 186 patients developed chronic pain after the operation. The most common symptom experienced by the patients was the enhanced sensitivity to cold in 69 % of the patients that led to pain and discomfort at temperatures that normally were perceived as being innocuously cool. Other symptoms were diminished sensitivity to stimulation in 55% of the patients and allodynia to light pressure, cold presented in 50% of the patients. The majority of the patients with pain resulting from traumatic or surgical nerve injury (77% of the patients) had no medication for pain, despite the presence of pain more than 50 VAS.Conclusions: Persistent neuropathic pain occured in 48% of the patients following nerve suture surgery. Cold intolerance has a high prevalence both in the group of patients with pain and in the group without pain.
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| 3. |
- Miclescu, Adriana, et al.
(författare)
-
The changing face of the acute pain
- 2016
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To distinguishthe risk factors associated with uncontrolled and problematic pain by prospectively assessing the current acute pain service (APS) activity in an academic hospital and theeffects of this activity on both surgical and medical pain intensity.Method: This prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before and after treatment. The patients were visited by APS at regular intervals and divided after the number of visits by APS team in several groups: group 1 (one visit and upto 2 follow ups); group 2 (3 to 4 follow-ups); group 3(5 to 10times follow-ups); group 4 (10 to 20 follow-ups); group 5 more than 20 follow–ups. The groups and the difference between groups were analyzed.Results: Patients (n=730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P=0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 3.4–5.3) to 6.3 (1.0–2.0) for the severe pain (p<0.0001), from 3.8 (3.1–3.8) to 2.4 (2.2–2.4) for the mild pain. Respiratory depression related to pain treatment was reported in 1.6% patients. The APS treated cognitive deficits related to pain treatment, in 30% of the patients, recognized and treated opioid overdose in 14%. The patients who required more than 5 visits by the APS(280 patients representing 38% of all the patients) demonstrated an increased prevalence of psychiatric diseases (from 10% in group 1 to 42% in group 5), opioid dependency (13% in group 1 to 100% in group 5) and chronic painresulted from both nociceptive (gradually increasing from 38% in group 1 to 85% in group 5) and neuropathic pain (from 13 % in group 1 increasing to 35% in group 5). The diagnoses encountered in the patients with frequent visits by the APS team were cancer related pain (17%), endometriosis (9%), reoperation(12%), burn injury(5%).Conclusions: Beside the benefits of APS in reducing of pain intensity, and in treating analgesia side effects, this study demonstrates the uncertain role of APS in the treatment of acute pain. The focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients who suffered adverse effects from pain treatment and have a high of comorbidities aspsychiatric diseases, opioid dependency and non-surgical chronic pain.
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