Sep
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2023
Effectiveness of Pain Management Following Electrical Injury
Li, Adrienne L. K. BASc; Gomez, Manuel MD, MSc; Fish, Joel S. MD, MSc, FRCS(C)
Journal of Burn Care & Research:
January/February 2010 – Volume 31 – Issue 1 – pp 73-82
doi: 10.1097/BCR.0b013e3181cb8e94
The purpose of this study was to evaluate the effectiveness of pain management after electrical injury. A retrospective hospital chart review was conducted among electrically injured patients discharged from the outpatient burn clinic of a rehabilitation hospital (July 1, 1999, to July 31, 2008). Demographic data, numeric pain ratings (NPRs) at initial assessment and discharge, medications, nonpharmacologic modalities, and their effects before admission and after rehabilitation were collected. Pain management effects were compared between high (≥1000 v) and low (<1000 v) voltage, and between electrical contact and electrical flash patients, using Student’s t-test and χ2, with a P < .05 considered significant. Of 82 electrical patients discharged during the study period, 27 were excluded because of incomplete data, leaving 55 patients who had a mean age ±SD of 40.7 ± 11.3 years, TBSA of 19.2 ± 22.7%, and treatment duration of 16.5 ± 15.7 months. The majority were men (90.9%), most injuries occurred at work (98.2%), mainly caused by low voltage (n = 32, 58.2%), and the rest caused by high voltage (n = 18, 32.7%). Electrical contact was more common (54.5%) than electrical flash (45.5%). Pain was a chief complaint (92.7%), and hands were the most affected (61.8%), followed by head and neck (38.2%), shoulders (38.2%), and back torso (38.2%). Before rehabilitation, the most common medication were opioids (61.8%), relieving pain in 82.4%, followed by acetaminophen (47.3%) alleviating pain in 84.6%. Heat treatment was the most common nonpharmacologic modality (20.0%) relieving pain in 81.8%, followed by massage therapy (14.5%) alleviating pain in 75.0%. During the rehabilitation program, antidepressants were the most common medication (74.5%), relieving pain in 22.0%, followed by nonsteroidal antiinflammatory drugs (61.8%), alleviating pain in 70.6%. Massage therapy was the most common nonpharmacologic modality (60.0%), alleviating pain in 75.8%, and then cognitive behavioral therapy (54.5%), alleviating pain in 40.0%. There were pain improvements in all anatomic locations after rehabilitation except for the back torso, where pain increased 0.7 ± 2.9 points. Opioids were more commonly used in high voltage (P < .05), and cognitive behavioral therapy in low-voltage injuries (P < .05). Opioids were used in both electrical flash and electrical contact injuries. Pain in electrically injured patients remains an important issue and should continue to be addressed in a multimodal way. It is hoped that this study will guide us to design future interventions for pain control after electrical injury.
Sep
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2023
BACKGROUND: Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use.
OBJECTIVES: To evaluate the effectiveness of touch therapies (including HT, TT, and Reiki) on relieving both acute and chronic pain; to determine any adverse effect of touch therapies.
SEARCH STRATEGY: Various electronic databases, including The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and others from their inception to June 2008 were searched. Reference lists and bibliographies of relevant articles and organizations were checked. Experts in touch therapies were contacted. SELECTION CRITERIA: Randomized Controlled Trials (RCTs) or Controlled Clinical Trials (CCTs) evaluating the effect of touch on any type of pain were included. Similarly, only studies using a sham placebo or a ‘no treatment’ control was included.
DATA COLLECTION AND ANALYSIS: Data was extracted and quality assessment was conducted by two independent review authors. The mean pain intensity for completing all treatment sessions was extracted. Pain intensity from different pain measurement scales were standardized into a single scale. Comparisons between the effects of treatment groups and that of control groups were made.
MAIN RESULTS: Twenty four studies involving 1153 participants met the inclusion criteria. There were five, sixteen and three studies on HT, TT and Reiki respectively. Participants exposed to touch had on average of 0.83 units (on a 0 to ten scale) lower pain intensity than unexposed participants (95% Confidence Interval: -1.16 to -0.50). Results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. Whether more experienced practitioners or certain types of touch therapy brought better pain reduction should be further investigated. Two of the five studies evaluating analgesic usage supported the claim that touch therapies minimized analgesic usage. The placebo effect was also explored. No statistically significant (P = 0.29) placebo effect was identified.
AUTHORS’ CONCLUSIONS: Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed. More studies including children are also required to evaluate the effect of touch on children.
Cochrane database of systematic reviews (Online) (4), pp. CD006535
Sep
5
2023
Pediatric oncology nurses can help maximize patient outcomes by assessing, advocating, and coordinating massage therapy services as a supportive care intervention.
This is the conclusion of a recent literature review that assess the integrating massage as a supportive care intervention for children with cancer.
According to the data synthesis’ authors, from the Division of Pediatric Oncology, Columbia University Medical Center, New York,
The authors reviewed more than 70 citations, using PubMed®, online references, published government reports, and the bibliographies of retrieved articles, reviews and books on massage and massage and cancer.
The authors found that Massage therapy may help mitigate pain, anxiety, depression, constipation, and high blood pressure and may be beneficial during periods of profound immune suppression. Massage techniques light to medium in pressure are appropriate in the pediatric oncology setting.
The authors concluded that Massage is an applicable, noninvasive, therapeutic modality that can be integrated safely as an adjunct intervention for managing side effects and psychological conditions associated with anticancer treatment in children. Massage may support immune function during periods of immunosuppression.
Reference:
Hughes D, Ladas E, Rooney D, Kelly K. Oncol Nurs Forum. 2008 May;35(3):431-42.
Sep
5
2023
People who have acute lower-back pain should undertake self-care and massage and spinal manipulation,
according to a recommendation from a study published in the Annals of Internal Medicine October 2007.
The study reccomends that for patients who do not improve with self-care options, clinicians (Doctors) should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.
The study was co-authored by the American College of Physicians and the American Pain Society. The Annals of Internal Medicine examined and gathered data from Medline studies, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Embase to formulate its lower-back pain guidelines. For full report on the guidelines see: http://www.annals.org/cgi/content/full/147/7/478
