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Chen R, Duan S, Wang Y, He F, Ren L, Peng W. Effects of music therapy on pain relief during fundus screening in infants: Randomized controlled clinical trial. Medicine (Baltimore) 2023; 102:e35878. [PMID: 37933026 PMCID: PMC10627706 DOI: 10.1097/md.0000000000035878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To determine the efficacy of music therapy on pain relief during fundus screening in infants. METHODS The sample consisted of infants aged 0 to 3 months who required fundus screening. Infants were randomized to fast music, slow music, and control groups. All groups underwent fundus screening under topical anesthesia. Music therapy was provided to the music groups prior to, during, and after the operation. The patient's heart rate (HR), transcutaneous oxygen saturation, and crying decibel were measured. The Face, Legs, Activity, Cry, Consolability scale was used for pain measurement. RESULTS A total of 300 subjects' data were collected. The quantitative analysis revealed that in both music groups, peripheral capillary oxygen saturation and satisfaction levels increased while pain scores decreased (P < .05). The slow music group's HR was shown to have significantly decreased (P < .05). CONCLUSION Music therapy can effectively reduce pain and crying, and increase blood oxygen saturation during fundus examination of infants. Music with a rhythm of 60 to 80 beats per minute can decrease HR. Music therapy must be remembered to increase infants' comfort during fundus examination.
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Affiliation(s)
- Renyi Chen
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Shijie Duan
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yin Wang
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Fengqin He
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Li Ren
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Wentao Peng
- Department of Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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2
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Tagele TD, Berhe YW, Lema GF. Knowledge and attitude towards pediatric pain management among nurses at Ethiopian tertiary hospitals; a multi-center study. BMC Nurs 2023; 22:84. [PMID: 36973798 PMCID: PMC10041723 DOI: 10.1186/s12912-023-01234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/06/2023] [Indexed: 03/28/2023] Open
Abstract
Background Pain is the most disturbing and annoying symptom experienced by children. However, it obtains poor attention in low- and middle-income countries particularly. The objective of this study was to assess knowledge, attitude and factors associated with pediatric pain management among nurses in tertiary hospitals in Northwest Ethiopia. Methodology : A multi-center cross-sectional study was conducted from March 1 to April 30, 2021. The knowledge and attitude of nurses were measured by using Nurses’ Knowledge and Attitudes Survey regarding Pain (P-NKAS). Descriptive and binary logistic regression analyses were performed to determine factors associated with knowledge and attitude. The strength of the association was presented by using adjusted odds ratio with 95% confidence interval and p-value < 0.05 was considered as statistically significant. Result A total of 234 (86.03% response rate) nurses were included and 67.1% of nurses had good knowledge and 89.3% had favorable attitudes towards pediatric pain management. The factors associated with good knowledge were having Bachelor’s Degree and above [AOR = 2.1, P = 0.015], having in-service training [AOR = 2.4, P = 0.008] and favorable attitude [AOR = 3.3, CI = 0.008]. The nurses who demonstrated good knowledge [AOR = 3.3, P = 0.003] and those who had Bachelor’s Degree and above [AOR = 2.8, P = 0.03] were found to have favorable attitude. Conclusion The nurses who were working in pediatrics care areas had good knowledge and favorable attitude towards pediatrics pain management. However, improvements are needed to eradicate misconceptions; particularly, on pediatrics pain perception, opioid analgesia, multimodal analgesia, and non-pharmacologic pain therapies. Nurses who had higher level of education, in-service training, favorable attitude were found to be knowledgeable. Furthermore, nurses who had higher levels of education and knowledge were found to have favorable attitude.
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Affiliation(s)
- Takele Dereje Tagele
- grid.448640.a0000 0004 0514 3385Department of Anesthesia, College of Medicine and Health Sciences, Aksum University, Aksum, Ethiopia
| | - Yophtahe Woldegerima Berhe
- grid.59547.3a0000 0000 8539 4635Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmay Fitiwi Lema
- grid.59547.3a0000 0000 8539 4635Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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3
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Li ZZ, Chang YC, Gu L, Zhou JF, Wei BR, Peng NH. Knowledge of Chinese Pediatric Professionals Regarding Pediatric Pain Management. Children (Basel) 2022; 9. [PMID: 36421234 DOI: 10.3390/children9111785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
Many healthcare professionals base their perceptions of pediatric pain on their knowledge of the subject. Therefore, knowledge deficits in this area may yield negative attitudes toward pain management and add to the complexity of pain management in hospitalized children. This study evaluated the knowledge of pediatric clinicians in China regarding pediatric pain management. Adopting a cross-sectional descriptive comparative design, we surveyed pediatric clinicians using a structured questionnaire. Inclusive criteria were pediatric clinicians, both pediatricians and nurses, with professional pediatric experience of over one year. A total of 507 pediatric clinicians participated. Most were aware of the importance of pain management in sick children but misunderstood pediatric pain, lacked knowledge for performing pediatric pain assessments and lacked knowledge for providing pain relief interventions. Background factors including differing professions (pediatricians and nurses; p = 0.012), age (p < 0.05) and hospital setting of employment (p = 0.003) were significantly related to clinicians’ knowledge regarding pain management. Participating pediatricians had higher levels of knowledge of pediatric pain management than nurses. Research revealed four barriers affecting clinicians’ knowledge, including misconception of pain in children, lack of professional knowledge and confidence in the practice of pediatric pain assessment, lack of professional knowledge to provide pain relief interventions, and a significant knowledge gap between pediatricians and nurses. The results point out a crucial need for multidisciplinary education to remedy these deficiencies. Further study is needed to explore strategies to strengthen clinicians’ knowledge of this vital area of practice.
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Plonski KS. Acupuncture for Pain Management in Pediatric Patients with Sickle Cell Disease. Children (Basel) 2022; 9:1076. [PMID: 35884060 DOI: 10.3390/children9071076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 02/02/2023]
Abstract
Pain management in an acute vaso-occlusive episode for pediatric patients with sickle cell disease (SCD) is challenging and often is focused on opioids, IV fluids, regional anesthesia, ketamine infusions, and non-steroidal anti-inflammatory drugs (NSAIDs). Acupuncture has long been studied as an effective method of pain relief, although the use of acupuncture in pediatric patients with SCD during an acute vaso-occlusive pain episode is vastly understudied. This article provides a review of current research regarding the use of acupuncture as a pain treatment strategy for pediatric patients with SCD experiencing acute pain. A literature review of scientific papers published within the last ten years was conducted on the topic. Five primary literature articles on acupuncture for pain management in pediatric patients with SCD were reviewed. Acupuncture is feasible and acceptable, with statistically significant findings for effectiveness as an adjunct treatment for pain in this setting. It is concluded that acupuncture is a promising and understudied therapy for the treatment of pain during an acute pain episode in pediatric patients with SCD. Hopefully, this paper stimulates interest in this specific area of medicine and prompts future research studies to be conducted to reveal conclusive outcomes.
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Cui X, Zhang J, Gao Z, Sun L, Zhang F. A randomized, double-blinded, placebo-controlled, single dose analgesic study of preoperative intravenous ibuprofen for tonsillectomy in children. Front Pediatr 2022; 10:956660. [PMID: 36052360 PMCID: PMC9424767 DOI: 10.3389/fped.2022.956660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Tonsillectomy is a recognized treatment for children with tonsil hypertrophy and results in significant postoperative oropharyngeal pain. Fentanyl and other morphine-like analgesics are widely used as perioperative analgesia but are associated with side effects such as vomiting, nausea, and respiratory depression. As the least toxic non-steroidal anti-inflammatory drug, ibuprofen may be effective and safe for pain control after tonsillectomy. We aimed to explore whether the addition of intravenous (IV) ibuprofen administered at induction can reduce the need for early postoperativeanalgesics. STUDY DESIGN AND METHODS This randomized, double-blind, controlled clinical trial enrolled 95 pediatric patients who underwent tonsillectomy. Participants aged 6 months to 12 years were randomly assigned to either the experimental and control groups (1:1). The children were premedicated 15 min before surgery with IV ibuprofen 10 mg kg-1 or placebo (normal saline). Pain was scored at 15, 30, and 120 min after extubation, and IV fentanyl (0.5 mcg kg-1) was administered when the Faces, Legs, Activity, Cry, and Consolability (FLACC) Scale was ≥7 and deemed appropriate by the nursing staff in the post-anesthesia care unit (PACU). The visual analog scale was used as a supplementary evaluation for older children (≥7 years old) who were awake and could self-report pain. The primary outcome variable was the number of patients who received postoperative analgesia. RESULTS The requirement for rescue fentanyl was reduced by 18% with the addition of IV ibuprofen (P = 0.043). There were no signficant differences in the amount of fentanyl administered postoperatively (P = 0.127). Compared with the placebo group, the number of children who needed more than one dose of rescue fentanyl decreased in the experimental group, but the differences were not significant (P = 0.056). There were no significant differences between the groups in terms of operative blood loss (P = 0.978), vomiting, or postoperative bleeding (P = 0.474). CONCLUSION It is safe to administer IV ibuprofen 15 min before tonsillectomy, and it can significantly reduce the need for rescue fentanyl. IV ibuprofen should be considered as an important part of the multimodal approach for postoperative analgesia in children. CLINICAL TRIAL REGISTRATION Chictr.org.cn, identifier: ChiCTR2100044508.
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Affiliation(s)
- Xiaohuan Cui
- Department of Anesthesiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jianmin Zhang
- Department of Anesthesiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhengzheng Gao
- Department of Anesthesiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lan Sun
- Department of Anesthesiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fuzhou Zhang
- Department of Anesthesiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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6
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Aaberg Lauridsen J, Lefort Sønderskov M, Hetmann F, Hamilton A, Salmi H, Wildgaard K. Investigating the use of physical restraint of children in emergency departments: A Scandinavian survey. Acta Anaesthesiol Scand 2021; 65:1116-1121. [PMID: 33866540 DOI: 10.1111/aas.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study is to describe the current frequency of physical restraint and the use of analgesics and sedatives for treating pediatric pain in emergency departments (EDs) in Scandinavia. METHODS We performed a nation-wide electronic survey asking nurses in the emergency departments in Denmark, Norway, and Sweden about their experience treating children in pain. RESULTS Responses from 103 Danish, Norwegian and Swedish nurses were included (79% response rate). Physical restraint was reported used at 79% [70.0-85.9] (N = 78) of the surveyed departments (DK: 96%, NO: 67%, SE: 77%) with two participants reporting daily use of physical restraint. Paracetamol was available at all departments and used most frequently. Sedation was available at 88% [78.8-92.0] of the departments with midazolam as the most recurrent sedative (83%, [74.8-89.4]). Seventy-three percent of respondents reported a need for better treatments. Lack of education was the most frequently reported obstacle for providing both pain treatment (29%) and sedation (43%) followed by lack of guidelines. CONCLUSION Physical restraint of children during painful procedures is used in the majority of Scandinavian emergency departments (79%). There appears to be a lack of local guidelines for both pain treatment and sedation.
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Affiliation(s)
- Julie Aaberg Lauridsen
- Department of Anaesthesiology and Herlev ACES Herlev Anaesthesia Critical and Emergency Care Science Unit Copenhagen University Hospital, Herlev‐Gentofte Copenhagen Denmark
| | | | - Fredrik Hetmann
- Department of Nursing and Health Promotion Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Annika Hamilton
- Department of Anaesthesiology Hvidovre University Hospital Hvidovre Denmark
| | - Heli Salmi
- Department of Anaesthesia and Intensive Care New Children's HospitalUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Kim Wildgaard
- Department of Anaesthesiology and Herlev ACES Herlev Anaesthesia Critical and Emergency Care Science Unit Copenhagen University Hospital, Herlev‐Gentofte Copenhagen Denmark
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Lo C, Ross PA, Le S, Kim E, Keefer M, Rosales A. Engaging Parents in Analgesia Selection and Racial/Ethnic Differences in Analgesia Given to Pediatric Patients Undergoing Urologic Surgery. Children (Basel) 2020; 7:children7120277. [PMID: 33297304 PMCID: PMC7762314 DOI: 10.3390/children7120277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Family-centered care aims to consider family preferences and values in care delivery. Our study examines parent decisions regarding anesthesia type (caudal regional block or local anesthesia) among a diverse sample of children undergoing urologic surgeries. Differences in anesthesia type were examined by known predictors of health disparities, including child race/ethnicity, parental English proficiency, and a proxy for household income. METHODS A retrospective review of 4739 patients (including 25.4% non-Latino/a White, 8.7% non- Latino/a Asians, 7.3% non-Latino/a Black, 23.1% Latino/a, and 35.4% others) undergoing urologic surgeries from 2016 to 2020 using univariate and logistic regression analyses. RESULTS 62.1% of Latino/a parents and 60.8% of non-Latino/a Black parents did not agree to a regional block. 65.1% of Spanish-speaking parents with limited English Proficiency did not agree to a regional block. Of parents from households below poverty lines, 61.7% did not agree to a caudal regional block. In regression analysis, Latino/a and non- Latino/a Black youth were less likely to receive caudal regional block than non- Latino/a White patients. CONCLUSIONS We found disparities in the use of pediatric pain management techniques. Understanding mechanisms underlying Latino/a and non- Latino/a Black parental preferences may help providers reduce these disparities.
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Affiliation(s)
- Carl Lo
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
- Correspondence:
| | - Patrick A. Ross
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Sang Le
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Eugene Kim
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Matthew Keefer
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Alvina Rosales
- Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (P.A.R.); (S.L.); (E.K.); (A.R.)
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8
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Peng NH, Lao AHC, Chen CH, Lee MC, Chiang LW, Chang YC, Liu HF. Knowledge and attitudes of pediatric clinicians regarding pediatric pain management. J SPEC PEDIATR NURS 2020; 25:e12302. [PMID: 32633052 DOI: 10.1111/jspn.12302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan. PURPOSE Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings. DESIGN AND METHODS A cross-sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire. RESULTS A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found. CONCLUSION The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals.
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Affiliation(s)
- Niang-Huei Peng
- School Nursing, Putian University, Putian Nursing University, Putian, Fujian Province, P.R. China
| | - Amy Hsuan-Chih Lao
- Department of Anesthesiology and Pain Management Center, Mackay Children's Hospital, Taipei, Taiwan
| | - Chao-Huei Chen
- Center for Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Min-Chun Lee
- Department of Pediatric, Buddhist Tzu Chi General Hospital, Taichung, Taiwan, ROC.,Department of Medicine, School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Li-Wen Chiang
- Pediatric Ward, Changhua Children's Hospital, Changhua City, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Tamsui, Taiwan
| | - Hsiu-Feng Liu
- Neonatal Intensive Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan
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Hilyard A, Kingsley J, Sommerfield D, Taylor S, Bear N, Gibson N. Feasibility of a Randomized Controlled Trial of Paediatric Interdisciplinary Pain Management Using Home-Based Telehealth. J Pain Res 2020; 13:897-908. [PMID: 32431538 PMCID: PMC7200248 DOI: 10.2147/jpr.s217022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care. Patients and Methods Parent-adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11-17) had experienced primary pain for >3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention. Results Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5-9 and Hybrid-PIPP median 8.5, range 5-10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported. Conclusion The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications. Registration ANZTR(ACTRN2614000489695).
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Affiliation(s)
- Anna Hilyard
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Julia Kingsley
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David Sommerfield
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Susan Taylor
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Child Research, Child Adolescent Health Service, Perth, Western Australia, Australia
| | - Noula Gibson
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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10
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Beuter C, Volkers G, Radic T, Goldberg J, van den Anker J. Efficacy and safety of multiple doses of tapentadol oral solution in the treatment of moderate to severe acute pain in children aged 2 to <18 years - a randomized, double-blind, placebo-controlled trial. J Pain Res 2019; 12:3099-3112. [PMID: 32009813 PMCID: PMC6859087 DOI: 10.2147/jpr.s207010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/30/2019] [Indexed: 12/27/2022] Open
Abstract
Background Well-controlled trials of analgesics in the pediatric population are scarce. Tapentadol is a strong centrally acting analgesic which has undergone a pediatric development program investigating its suitability for treating moderate to severe acute pain across the entire pediatric age range from birth to adolescence. Here, we report data from a pivotal Phase III trial performed as part of this development program. Patients and methods This randomized, double-blind, placebo-controlled, multicenter clinical trial investigated efficacy and safety/tolerability of multiple tapentadol oral solution doses (OS; target dose 1.25 mg/kg) in the treatment of postsurgical acute pain. Data for patients aged 2 to <18 years are reported here. The main objective of the trial was to investigate if oral tapentadol administration compared to placebo reduces the use of supplemental opioid analgesic medication within the first 24 hrs of treatment. Other investigated parameters included taste and palatability of the trial medication, adverse events (AEs), vital signs, and laboratory parameters. Results A total of 160 patients were included (placebo n=52, tapentadol n=108). It was shown that the total amount of supplemental opioid analgesic medication used in the first 24 hrs was significantly lower in tapentadol patients than placebo patients (p=0.0154). Taste and palatability of tapentadol OS was well perceived by most patients. Treatment-emergent AEs were reported in 50% of patients treated with placebo vs 57.4% in those exposed to tapentadol, most commonly vomiting, nausea, and constipation in both treatment groups. Conclusion Tapentadol OS was effective and generally well tolerated in children (≥2 years) for the treatment of moderate to severe acute pain. Across all age groups, palatability and acceptability of tapentadol OS were sufficient to ensure intake compliance. This trial provides evidence that tapentadol OS can be effectively used to treat pain in young patients for whom currently limited labelled treatment options are available.
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Affiliation(s)
| | | | | | | | - John van den Anker
- Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA
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11
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Muse D, Tarau E, Lefeber C, Sohns M, Brett M, Goldberg J, Rosenburg R. Pharmacokinetics, safety, and efficacy of tapentadol oral solution for treating moderate to severe pain in pediatric patients. J Pain Res 2019; 12:1777-1790. [PMID: 31213888 PMCID: PMC6549717 DOI: 10.2147/jpr.s197039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background: This trial is part of the global pediatric clinical development program investigating the administration of the strong analgesic tapentadol in children and adolescents. Patients and methods: The single site, open-label phase 2 trial evaluated the pharmacokinetic profile of tapentadol and its major metabolite, tapentadol-O-glucuronide, as well as safety and tolerability and efficacy of a single dose of tapentadol oral solution (1 mg/kg) in patients (2 to <18 years) undergoing dental, ear, nose, or throat surgery. Blood sampling and pain intensity measurements were conducted using age-appropriate schedules and rating scales, respectively. Adverse events were monitored throughout the trial. Results: Sixty-six patients were treated. They were stratified by age: Group 1 (12 to <18 years), n=21; Group 2 (6 to <12 years), n=28; and Groups 3 (3 to <6 years) and 4 (2 to <3 years), n=17. Serum tapentadol concentrations observed in these pediatric patients were within the range observed in adults after administration of a single tapentadol immediate-release dose (50-100 mg), whereas those of the metabolite tapentadol-O-glucuronide were within the same range or lower than in adults who received comparable single doses of tapentadol. Pain intensity improved over time across all age groups. The most common treatment-emergent adverse events were nausea (24.2%), vomiting (16.7%), dizziness (9.1%), and headache (6.1%). Conclusion: A single dose of tapentadol oral solution (1 mg/kg) administered to pediatric patients (2 to <18 years) resulted in serum tapentadol concentrations within the targeted range shown to be safe and efficacious in adults. Tapentadol demonstrated good tolerability and safety; within the limitations of the trial design, improvements in postsurgical pain intensity were observed across the age groups. Tapentadol may provide a new treatment option in the management of moderate to severe pediatric pain.
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Affiliation(s)
- Derek Muse
- Jean Brown Research, Salt Lake City, UT, USA
| | - Eva Tarau
- Grünenthal USA Inc., Overland Park, KS, USA
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Teets M, Tumin D, Walia H, Stevens J, Wrona S, Martin D, Bhalla T, Tobias JD. Rapid Response Team activation for pediatric patients on the acute pain service. Paediatr Anaesth 2017; 27:1148-1154. [PMID: 29030935 DOI: 10.1111/pan.13237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. METHODS A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team. Two independent practitioners reviewed electronic medical records to determine which events were likely associated with pain management interventions. RESULTS Over a 4-year period, 4872 patients were admitted to the acute pain service of whom 135 unique patients required Rapid Response Team consults. There were 159 unique Rapid Response Team activations among 6538 unique acute pain service consults. A subset of 27 pain management-related Rapid Response Team consultations was identified. The largest percentage of patients on the acute pain service were adolescents aged 12-17 (36%). Compared to this age group, the odds of Rapid Response Team activation were higher among infants <1 year old (odds ratio = 2.85; 95% confidence interval: 1.59, 5.10; P < .001) and adults over 18 years (odds ratio = 1.68; 95% confidence interval: 1.01, 2.80; P = .046). DISCUSSION Identifying demographics and etiologies of acute pain service patients requiring Rapid Response Team consultations may help to identify patients at risk for clinical decompensation.
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Affiliation(s)
- Maxwell Teets
- Department of Anesthesiology, New York University Langone Medical Center, New York, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Hina Walia
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Jenna Stevens
- Comprehensive Pain and Palliative Care Services, Nationwide Children's Hospital, Columbus, USA
| | - Sharon Wrona
- Comprehensive Pain and Palliative Care Services, Nationwide Children's Hospital, Columbus, USA
| | - David Martin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Tarun Bhalla
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, USA
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