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The initial evaluation of pain should include:
Pleasant mental images can be used to aid relaxation. For example,patients might be encouraged to visualize a peaceful scene, such aswaves softly hitting the beach, or to take slow, deep breaths as theyvisualize pain leaving the body. Both pleasant imagery and progressivemuscle relaxation have been shown to decrease self-reported painintensity and pain distress
The sibling relationship is a natural laboratory for young children to learn about their world.3 It is a safe and secure place to learn how to interact with others who are interesting and engaging playmates, to learn how to manage disagreements, and to learn how to regulate both positive and negative emotions in socially acceptable ways.33 There are many opportunities for young children to develop an understanding of social relations with family members who may be close and loving at times and nasty and aggressive at other times. Further, there are many opportunities for siblings to use their cognitive skills to convince others of their point of view, teach or imitate the actions of their sibling. The positive benefits of establishing warm and positive sibling relationships may last a lifetime, whereas more difficult early relationships may be associated with poor developmental outcomes. The task for young siblings is to find the balance between the positive and negative aspects of their interactions as both children develop over time.
The Handbook of research synthesis (Book, 1994 ..
Opioids are the major class of analgesics used in the management ofmoderate to severe pain because of their effectiveness, ease oftitration, and favorable risk-to-benefit ratio. Opioids produceanalgesia by binding to specific receptors both within and outside theCNS Opioid analgesics are classified as fullagonists, partial agonists, or mixed agonist-antagonists, depending onthe specific receptors to which they bind and their intrinsic activityat that receptor.
It is impossible to predict which NSAID will be best tolerated by aparticular patient; no particular NSAID has demonstrated superiorityover others for pain relief. Once an NSAID has been selected, the doseshould be increased until pain has been relieved or the maximalrecommended dose has been achieved. The duration of analgesia does notalways correlate with the serum half-life of the NSAID. Therefore, theresponse of the patient should guide the clinician in selecting dosingintervals of these agents. Because NSAIDs and adjuvant analgesics haveceiling effects to their efficacy, if a patient does not respond to themaximal dose of one NSAID, another should be tried beforediscontinuation of NSAID therapy. The initial choice of NSAID should bebased on the efficacy, safety, and relative expense; generally, theleast expensive NSAID should be chosen.
The Handbook of Research Synthesis and Meta-Analysis ..
Commonly used full agonists include morphine, hydromorphone, codeine,oxycodone, hydrocodone, methadone, levorphanol, and fentanyl. Theseopioids are classified as full agonists because they do not have aceiling to their analgesic efficacy and will not reverse orantagonize the effects of other opioids within this class givensimultaneously. Side effects include constipation, nausea, urinaryretention, confusion, sedation, and respiratory depression.
Mixed agonist-antagonists in clinical use include pentazocine,butorphanol tartrate, dezocine, and nalbuphine hydrochloride. Thesedrugs have an analgesic ceiling. In contrast to full agonists, thesedrugs block opioid analgesia at one type of opioid receptor (mu) or areneutral at this receptor while simultaneously activating a differentopioid receptor (kappa). Patients receiving full opioid agonistsshould not be given a mixed agonist-antagonist because doing so mayprecipitate a withdrawal syndrome and increase pain.
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The Handbook of Research Synthesis - Google Books
Most NSAIDs are available as oral tablets, caplets, or capsules, andseveral are available as oral liquids. Rectal suppositories of aspirin, acetaminophen, and other NSAIDs are commercially availableor can be compounded easily by pharmacists. Ketorolac tromethamine isthe only NSAID that is currently available for short-term parenteraladministration. provides dosing data foracetaminophen and NSAIDs.
The Handbook of research synthesis (eBook, 1994 ..
NSAIDs bind extensively to plasma proteins and therefore may bedisplaced by or may displace other protein-bound drugs such as coumadin,methotrexate, digoxin, cyclosporine, oral antidiabetic agents, and sulfadrugs. Such interactions may enhance therapeutic or toxic effects ofeither drug. The use of NSAIDs has been associated with both minor(dyspepsia, heartburn, nausea, vomiting, anorexia, diarrhea,constipation, flatulence, bloating, epigastric pain, and abdominal pain)and major (bleeding, ulceration, and perforation) GI toxicities. Seriouseffects are not always preceded by minor GI effects; patients should beadvised to report any GI disturbances.
A Handbook of Research Synthesis
Morphine is the most commonly used opioid for moderate to severe painbecause of its availability in a wide variety of dosage forms, itswell-characterized pharmacokinetics and pharmacodynamics, and itsrelatively low cost.
Research synthesis involves formulating a research problem, ..
Meperidine may be useful for brief courses (e.g., a few days) totreat acute pain and to manage rigors (shivering) induced by medication,but it generally should be avoided in patients with cancer because ofits short duration of action (2.5 to 3.5 hours) and its toxicmetabolite, normeperidine. This metabolite accumulates, particularlywhen renal function is impaired, and causes CNS stimulation, which maylead to dysphoria, agitation, and seizures Therefore, meperidine shouldnot be used if continued opioid use is anticipated.
The Handbook of Research Synthesis and Meta-Analysis
The nonacetylated salicylates such as salsalate, sodium salicylate,and choline magnesium trisalicylate do not affect platelet aggregationprofoundly and do not alter bleeding time Aspirin, the prototype ofthe acetylated salicylate, produces an irreversible inhibition ofplatelet aggregation, which may prolong bleeding time for up to severaldays after ingestion The nonacetylatedsalicylates, such as sodium salicylate and choline magnesiumtrisalicylate, have minimal effects on platelet aggregation and do notappearto alter bleeding time clinically Other NSAIDs produce areversible inhibition of platelet aggregation, which persists while thedrug is in the systemic circulation Therefore, with the exception of the nonacetylatedsalicylates noted above, NSAIDs should be avoided if possible inpatients who are thrombocytopenic or who have a clotting impairment.
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