Abstract
The paper discusses an article entitled "Patient-Controlled Transdermal Fentanyl Hydrochloride vs Intravenous Morphine Pump for Postoperative Pain: A Randomized Controlled Trial," where Viscusi et al. report on a study conducted in North American hospitals between September 2000 and March 2001. The objective of this study was to ascertain whether problems with existing patient-controlled analgesia (PCA) for postoperative surgery patients could be overcome by switching to an alternative method and drug.

From the Paper
"Instead of using morphine analgesics infused via an IV line, the proposed alternative therapy would utilize fentanyl hydrochloride, administered transdermally via a patient-controlled low-intensity direct current that would move the fentanyl from a hydrogel reservoir in a patch, into the skin."

Tags:nurse, pain, patientcontrolled

From the Paper
"The pain of childbirth is known to be one of the most severe pains a woman can experience. In recent years, the use of epidural analgesia has become widespread and women need no longer suffer excruciating pain while giving birth. This paper will look at the advantages of giving birth with the aid of an epidural, and how it can make the birthing process a more satisfactory event for women.
During the first stage of labor, visceral distention as a result of rhythmic uterine contractions and progressive dilation of the cervix result in the transmission of afferent impulses from the uterus and cervix to the spinal cord at T10 through L1 (Vincent and Chestnut 1786). These events produce severe pain in the lower abdomen, lower back, and sacrum. These pains can be excruciating if no analgesic is given. The pain experienced during.."

Abstract
This paper focuses its analysis on the treatment of pain, or oligoanalgesia, in the setting of hospital emergency rooms. The paper explains that pain is a complex neurobiological problem that involves the nervou, cognitive, and emotional systems, and its highly subjective nature makes its assessment and management a complex problem. The paper notes that multimodal or combinational therapy is found to be the most effective in providing relief from acute pain. The paper opines that analgesia should be given a high priority in the ED setting. The paper also discusses pseudo addiction, and how it often leads to under treatment of chronic pain. The paper concludes that there is enough research evidence to suggest that a framework for pain management should be formulated and implemented in all hospital emergency departments, which would definitely reduce patient waiting time and improve pain management outcome.

Outline:
Abstract
Introduction
Pathology of Pain
Psychology of Pain
Chronic Pain in the ED
Training for Acute Pain Management
Addictive Personality and Pseudo Addiction
Treatment Modality
Conclusion
References

From the Paper
"One of the major issues revolving around pain care medication is the possibility of abuse. While in most cases patients are under treated there is also a significant percentage of emergency department visits by patients who have developed an addiction to opiate analgesics and other synthetic drugs. On the other hand over suspicion and interrogation may lead to oligonalgesia leaving the patient under treated and highly dissatisfied. Identifying this drug seeking behavior from genuine patients is a big problem for the physician. However, it is necessary that the patient presenting to the ED be screened for possible drug abuse and provided substance abuse treatment. A 1996 research by Rocket et.al involved an extensive study of patients in Tennessee emergency departments. The study observed that while 23% of these patients were identified as requiring substance abuse treatment only 1% was clinically documented for alcohol or drug related problems. This shows the underreported and largely ignored nature of substance abuse problem and the largely unmet treatment requirement for substance abuse. A subsequent study by the same author analyzed the cost effects of providing abuse related treatment in the ED. It was found that Tennessee patients with unmet substance abuse treatment incurred an addition of 777 million dollars to the ED treatment costs. It was concluded that the cost of ED screening and treatment of substance abuse would be more than compensated by the cost savings resulting from the decrease in the frequency of visits to ED. [11]"

Tags:oligoanalgesia, relief, analgesia

Abstract
The paper reveals that the instances of African-American women declining to be administered an epidural to alleviate the pain is high. The paper explains that this is due to several factors that are all culturally oriented; fear of having an injection in the spine to control pain, lack of insurance coverage for the procedure and cultural support for women having "natural" childbirth. The paper explains that an epidural is an injection of analgesia that is made in the spinal column during the process of labor to numb the woman's body, thereby relaxing her and ceasing the tremendous pain that is connected to giving birth. The paper further explains that the dominant philosophy behind administered epidurals during labor by physicians is that once the body is capable of relaxation, the patient will deliver the baby more rapidly and the mother will not have to suffer childbirth pain for an extended period of time.

From the Paper
"Atherton, Feeg and El-Adham (2004) contend that when labor pain occurs, the instances of African American women declining to be administered an epidural to alleviate the pain is high (p. 6). This is due to several factors that Atherton, Feeg and El-Adham (2004) suggest are all culturally oriented. Fear of having an injection in the spine to control pain, lack of insurance coverage for the procedure and cultural support for women having "natural" childbirth all appear to be reasons that most Black women choose to endure the pain of birth rather than agree to have an epidural..."

Tags:nursing, education, culture

Abstract
This paper analyzes and critiques the article "Assessment of Pain in Cognitively Impaired Older Adults: A Comparison of Pain Assessment Tools and their Use by Non-professional Caregivers," by Krulewitch et al., published in the Journal of the American Geriatric Society. The writer examines each step of the study in detail and discusses its strengths and limitations. The writer concludes that the limitations of this study may guide future researchers in launching similar and more successful studies in this field.

Outline
Research Problem and Purpose
Hypotheses and Research Question
Literature Review
Theoretical or Conceptual Framework
Population
Protection of Human Participants
Research Design
Instruments and Strategies for Measurement
Data Collection
Data Analysis
Interpretation of Results
Discussion of Findings
Limitations
Implications
Recommendations
Research Utilization in my Practice

From the Paper
"Pain was measured using a standardized pain assessment (Krulewitch et al., 2000, 1612). This assessment was administered to all participants in the study. The researchers used several scales in the study. The MMSE was used to determine dementia, along with documented diagnosis as such. The face pain scale and the nonverbal visual analog pain scale were used to determine moderate to sever pain. The researchers of the study report that one-third of demented subjects were unable to rate pain using any of the tools, but had had a pain assessment during the designated time of the study. Researchers point out those who were assessing the subjects for pain may have been unaware of the degree of pain experienced by the demented individual."

Tags:psychotropic, health care, medication mortality analgesia nurse

Abstract
This paper discusses the importance and use of multi-modal pharmacological therapy, particularly in the management of post-operative pain. The paper presents a case study of a patient who has recently undergone surgery and describes the use of multi-modal pharmacological therapy throughout the patient's recovery period.

Table of Contents:
Introduction
Analgesic Agents Used
Patient Assessment and Safety Considerations
Conclusion

From the Paper
"However, the patient must be made aware of all that was, and is being done to her, as it would be futile to expect expedient recovery without informing the patient (ideally beforehand) regarding what she could expect post-operatively. The aim of this is self-empowerment. Orem's theories, particularly on self-care have played pivotal roles in accomplishing patient empowerment. Orem's Theory of Self-Care is significant in the realm of patient education, especially in this case because events such as pregnancy and birth are often life-altering. It is essential that the nurse also take on the role of the learner as well. In the process, the nurse becomes more introspective about herself and can more adeptly communicate the tools needed by the patient to carry on with guided self-care requisites."

Tags:analgesia, epidural, self-care, cesarean