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Early analgesia for children with acute abdominal pain: Is it applicable without affecting diagnostic accuracy?
48 chronic pain. The follow-up consisted of a 14-day symptom diary and telephone interviews 1, 6 and 12 months after surgery. The 14-day consumption of analgesics was similar in the 30 PVB and the 30 control patients. However, 1 month after surgery, the intensity of motion-related pain was lower (P = 0.005) in the PVB group. Six months after surgery, the prevalence of any pain symptoms (P = 0.029) was lower in the PVB group. Finally, at 12 months after surgery, in addition to the prevalence of pain symptoms (P = 0.003) and the intensity of motion-related pain (P = 0.003), the intensity of pain at rest (P = 0.011) was lower in the PVB group. These findings were independent of whether or not axillary dissection had been performed. The incidence of neuropathic pain was low (two and three patients in the PVB and control groups, respectively). In addition to providing acute postoperative pain relief, preoperative PVB seems to reduce the prevalence of chronic pain 1 year after breast cancer surgery. ©2006 by International Anesthesia Research Society. doi:10.1016/j.acpain.2007.02.012 Phantom breast sensations and phantom breast pain: A 2-year prospective study and a methodological analysis of literature
Abstracts were weighted according to the number of women investigated. Linear regression analysis was performed to analyse the influences of methodology on the prevalences of PB sensations and PB pain. Of the 29 studies identified, 23 were cross-sectional and six were prospective. In 17 studies patients were interviewed and in 12 studies a questionnaire was used. A prospective design resulted in prevalences of PB sensations and PB pain averagely 8% lower respectively 9% higher than in cross-sectional studies. The use of an interview resulted in prevalences of PB sensations and PB pain averagely 13% lower respectively 5% lower than questionnaire use. Prevalences of PB sensations and PB pain reduce averagely with 0.08% respectively 0.13% per year since 1950. It is concluded that research design and assessment method have a significant influence on reported prevalence of PB sensations and PB pain. ©2006 European Federation of Chapters of the International Association for the Study of Pain. doi:10.1016/j.acpain.2007.02.013 ACUTE PAIN IN EMERGENCY DEPARTMENTS Early analgesia for children with acute abdominal pain: Is it applicable without affecting diagnostic accuracy?
Eur J Pain: Ejp 2007;11(1):99—108 Dijkstra P.U., Rietman J.S., Geertzen J.H.B.
Medico e Bambino 2006;25(8):519—24 (date of publication: 31 October 2006) Radzik D., Zaramella C.
The first aim of this study was to assess prospectively the incidence of phantom breast sensations (PB sensations) and phantom breast pain (PB pain) in a sample of patients treated for breast cancer (n = 204) by means of a modified radical mastectomy (n = 82). Patients were assessed 6 weeks, 6, 12 and 24 months after mastectomy, by means of a questionnaire. After 24 months, assessments of 74 (90%) patients were available. Two years after mastectomy, PB sensations were present in 19% (n = 14) of the patients and PB pain was present in 1% (n = 1) of the patients. Over time the percentage of patients with PB sensations remained relatively stable (around 20%) but for PB pain the percentage reduced from 7 to 1%. The amount of suffering as a result of PB sensations or PB pain was very limited. PB sensations and PB pain are of little clinical relevance in the 24 months following mastectomy. The second aim of this paper was to analyse the influence of research methodology on the prevalences of PB sensations and PB pain previously reported. Research design, assessment method and publication date were recorded. Data
Background: Many paediatricians and surgeons are reluctant to use analgesics in children with acute abdominal pain for the fear of masking symptoms and delaying a possible diagnosis of appendicitis. Over the past few years this traditional belief has been challenged, after the publication of several controlled trials performed on adult patients, showing that early analgesia in this context is safe. Objective: We systematically reviewed the literature, searching which is the best available evidence for effectiveness and safety of analgesics in paediatric patients with abdominal pain. Data sources: Medline, Embase, Cochrane Register of Controlled Trials. Results: Three double blind Randomized Controlled Trials comparing opioids with placebo were retrieved. The overall methodological quality of these studies was good. With active treatment there was a greater decrease in pain score, with no delay in surgical intervention and no significant change in the ability of physicians of making a correct diagnosis. No important complication was
Abstracts eventually documented. A ‘post hoc’ power calculation has shown that all these trials were not large enough to detect a statistical difference with regard to the main outcomes. Conclusions: The use of analgesia effectively reduces the intensity of pain in children with acute abdominal pain and does not interfere with diagnostic accuracy. The small sample size of the studies included in our review should however be considered a potential limitation to their results. doi:10.1016/j.acpain.2007.02.014 PAIN ASSESSMENT ACUTE PAIN IN CHILDREN Psychoeducational preparation of children for surgery: The importance of parental involvement Pat Educ Counsel 2007;65(1):34—41 Li H.C.W., Lopez V., Lee T.L.I. Objective: To examine the effects of therapeutic play intervention on outcomes of children undergoing day surgery, and to highlight the importance of parental involvement in the psychoeducational preparation of children for surgery. Methods: A randomized controlled trial, two group pre-test and repeated post-test, between subjects design was employed. Hong Kong Chinese children (7—12 years of age; n = 203) admitted for elective surgery in a day surgery unit, along with their parents during a 13-month period, were invited to participate in the study. By using a simple complete randomization method, 97 of children with their parents were assigned to the experimental group receiving therapeutic play intervention, and 106 children with their parents were assigned to the control group receiving routine information preparation. Results: The results showed that both children and their parents in the experimental group reported lower state anxiety scores in pre- and post-operative periods. Children in the experimental group exhibited fewer instances of negative emotional behaviours and parents in the experimental group reported greater satisfaction. The results, however, find no differences in children’s post-operative pain between the two groups. Conclusion: The study provides empirical evidence to support the effectiveness of using therapeutic play intervention and the importance of parental involvement in the psychoeducational preparation of children for surgery. Practice impli-
49 cations: The findings heighten the awareness of the importance of integrating therapeutic play and parental involvement as essential components of holistic and quality nursing care to prepare children for surgery. ©2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.acpain.2007.02.015 The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates A systematic literature review Eur J Pain: Ejp 2007;11(2):139—52 Cignacco E., Hamers J.P.H., Stoffel L., van Lingen R.A., Gessler P., McDougall J., Nelle M. Background: Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviouroriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment. Aims: To identify effective non-pharmacological interventions with regard to procedural pain in neonates. Methods: A literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed. Results: Thirteen randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were ‘non-nutritive sucking’, ‘music’, ‘swaddling’, ‘positioning’, ‘olfactory and multisensorial stimulation’, ‘kangaroo care’ and ‘maternal touch’. There is evidence that the methods of ‘nonnutritive sucking’, ‘swaddling’ and ‘facilitated tucking’ do have a pain-alleviating effect on neonates. Conclusions: Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. How-
Abstracts were weighted according to the number of women investigated. Linear regression analysis was performed to analyse the influences of methodology on the prevalences of PB sensations and PB pain. Of the 29 studies identified, 23 were cross-sectional and six were prospective. In 17 studies patients were interviewed and in 12 studies a questionnaire was used. A prospective design resulted in prevalences of PB sensations and PB pain averagely 8% lower respectively 9% higher than in cross-sectional studies. The use of an interview resulted in prevalences of PB sensations and PB pain averagely 13% lower respectively 5% lower than questionnaire use. Prevalences of PB sensations and PB pain reduce averagely with 0.08% respectively 0.13% per year since 1950. It is concluded that research design and assessment method have a significant influence on reported prevalence of PB sensations and PB pain. ©2006 European Federation of Chapters of the International Association for the Study of Pain. doi:10.1016/j.acpain.2007.02.013 ACUTE PAIN IN EMERGENCY DEPARTMENTS Early analgesia for children with acute abdominal pain: Is it applicable without affecting diagnostic accuracy?
Eur J Pain: Ejp 2007;11(1):99—108 Dijkstra P.U., Rietman J.S., Geertzen J.H.B.
Medico e Bambino 2006;25(8):519—24 (date of publication: 31 October 2006) Radzik D., Zaramella C.
The first aim of this study was to assess prospectively the incidence of phantom breast sensations (PB sensations) and phantom breast pain (PB pain) in a sample of patients treated for breast cancer (n = 204) by means of a modified radical mastectomy (n = 82). Patients were assessed 6 weeks, 6, 12 and 24 months after mastectomy, by means of a questionnaire. After 24 months, assessments of 74 (90%) patients were available. Two years after mastectomy, PB sensations were present in 19% (n = 14) of the patients and PB pain was present in 1% (n = 1) of the patients. Over time the percentage of patients with PB sensations remained relatively stable (around 20%) but for PB pain the percentage reduced from 7 to 1%. The amount of suffering as a result of PB sensations or PB pain was very limited. PB sensations and PB pain are of little clinical relevance in the 24 months following mastectomy. The second aim of this paper was to analyse the influence of research methodology on the prevalences of PB sensations and PB pain previously reported. Research design, assessment method and publication date were recorded. Data
Background: Many paediatricians and surgeons are reluctant to use analgesics in children with acute abdominal pain for the fear of masking symptoms and delaying a possible diagnosis of appendicitis. Over the past few years this traditional belief has been challenged, after the publication of several controlled trials performed on adult patients, showing that early analgesia in this context is safe. Objective: We systematically reviewed the literature, searching which is the best available evidence for effectiveness and safety of analgesics in paediatric patients with abdominal pain. Data sources: Medline, Embase, Cochrane Register of Controlled Trials. Results: Three double blind Randomized Controlled Trials comparing opioids with placebo were retrieved. The overall methodological quality of these studies was good. With active treatment there was a greater decrease in pain score, with no delay in surgical intervention and no significant change in the ability of physicians of making a correct diagnosis. No important complication was
Abstracts eventually documented. A ‘post hoc’ power calculation has shown that all these trials were not large enough to detect a statistical difference with regard to the main outcomes. Conclusions: The use of analgesia effectively reduces the intensity of pain in children with acute abdominal pain and does not interfere with diagnostic accuracy. The small sample size of the studies included in our review should however be considered a potential limitation to their results. doi:10.1016/j.acpain.2007.02.014 PAIN ASSESSMENT ACUTE PAIN IN CHILDREN Psychoeducational preparation of children for surgery: The importance of parental involvement Pat Educ Counsel 2007;65(1):34—41 Li H.C.W., Lopez V., Lee T.L.I. Objective: To examine the effects of therapeutic play intervention on outcomes of children undergoing day surgery, and to highlight the importance of parental involvement in the psychoeducational preparation of children for surgery. Methods: A randomized controlled trial, two group pre-test and repeated post-test, between subjects design was employed. Hong Kong Chinese children (7—12 years of age; n = 203) admitted for elective surgery in a day surgery unit, along with their parents during a 13-month period, were invited to participate in the study. By using a simple complete randomization method, 97 of children with their parents were assigned to the experimental group receiving therapeutic play intervention, and 106 children with their parents were assigned to the control group receiving routine information preparation. Results: The results showed that both children and their parents in the experimental group reported lower state anxiety scores in pre- and post-operative periods. Children in the experimental group exhibited fewer instances of negative emotional behaviours and parents in the experimental group reported greater satisfaction. The results, however, find no differences in children’s post-operative pain between the two groups. Conclusion: The study provides empirical evidence to support the effectiveness of using therapeutic play intervention and the importance of parental involvement in the psychoeducational preparation of children for surgery. Practice impli-
49 cations: The findings heighten the awareness of the importance of integrating therapeutic play and parental involvement as essential components of holistic and quality nursing care to prepare children for surgery. ©2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.acpain.2007.02.015 The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates A systematic literature review Eur J Pain: Ejp 2007;11(2):139—52 Cignacco E., Hamers J.P.H., Stoffel L., van Lingen R.A., Gessler P., McDougall J., Nelle M. Background: Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviouroriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment. Aims: To identify effective non-pharmacological interventions with regard to procedural pain in neonates. Methods: A literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed. Results: Thirteen randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were ‘non-nutritive sucking’, ‘music’, ‘swaddling’, ‘positioning’, ‘olfactory and multisensorial stimulation’, ‘kangaroo care’ and ‘maternal touch’. There is evidence that the methods of ‘nonnutritive sucking’, ‘swaddling’ and ‘facilitated tucking’ do have a pain-alleviating effect on neonates. Conclusions: Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. How-