A pediatric patients’ pain evaluation in the emergency unit

A pediatric patients’ pain evaluation in the emergency unit Poster-abstracts from SASP 2013 / Scandinavian Journal of Pain 4 (2013) 255–260to improve the pain management practices in the hospital, with aninitial emphasis on pain assessment.http://dx.doi.org/10.1016/j.sjpain.2013.07.007A6Promising effects of donepezil when added topatients treated with gabapentin forneuropathic painA. Basnet 1 , S. Butler 2 , P. Hartvig Honoré 1 , M.Butler 2 , T.E. Gordh 2 , K. Kristensen 3 , O.J.Bjerrum 11 Department of Drug Design and Pharmacology,University of Copenhagen, Denmark2 Multidisciplinary Pain Centre, Uppsala UniversityHospital, Sweden3 Novo Nordisk A/S, Måløv, DenmarkAims: The clinical relevance of adding the acetylcholinesteraseinhibitor donepezil to existing gabapentin treatment in patientswith post-traumatic neuropathic pain was explored in this openlabel study. The two drugs have previously shown synergismfollowing co-administration in nerve-injured rats [1,2].Methods: The study comprised two consecutive periods of minimum six weeks: (1) titration of gabapentin until highest tolerabledose or maximum 2400 mg daily; and (2) addition of donepezil5 mg once daily to the fixed gabapentin dose. Efficacy and tolerability were assessed by ratings of pain intensity, questionnairesfor pain and health-related quality of life, and reporting of adverseevents and analgesic rescue medication. Pain scores were also analyzed using mixed-effects analysis (i.e. incorporating inter-subjectvariability) with the software NONMEM.Results: Eight patients commenced treatment with donepezilupon the gabapentin titration period, of which two withdrew dueto adverse events. Addition of donepezil reduced pain by >35% infour of six patients compared to gabapentin monotherapy. Mixedeffects analysis revealed that pain scores were significantly lowerduring co-administration (p < 0.05 combination vs. monotherapy).Donepezil was well tolerated in combination with gabapentin. Atthe end of study, three patients wished to continue combinationtherapy with gabapentin and donepezil.Conclusion: Donepezil may provide additional analgesia to neuropathic pain patients with insufficient pain relief from gabapentinas monotherapy. Further confirmation in controlled clinical trialsis justified. Mixed-effects analysis was sensitive enough to detectstatistically significant effects, showing its usefulness in small-scaletrials and/or when data is associated with high variability.References[1] Folkesson A, Hartvig Honoré P, Munkholm Andersen L, Kristensen P, Bjerrum OJ.Low dose of donepezil improves gabapentin analgesia in the rat spared nerveinjury model of neuropathic pain: single and multiple dosing studies. J NeuralTransm 2010;117:1377–85.[2] Hayashida K, Parker R, Eisenach JC. Oral gabapentin activates spinal cholinergiccircuits to reduce hypersensitivity after peripheral nerve injury and interactssynergistically with oral donepezil. Anesthesiology 2007;106:1213–9.http://dx.doi.org/10.1016/j.sjpain.2013.07.008257A7A pediatric patients’ pain evaluation in theemergency unitAnette LemströmHelsinki University Central Hospital, Hospital forChildren and Adolescents, Helsinki, FinlandAims: Helsinki University Hospital for Children and Adolescentstreats 0- to 16-year old pediatric and surgical patients. The patientsarrive to the emergency unit by ambulance, referral or by decision of the triage nurse. The most common reason for visit is pain.VAS pain scale should be used, but pain is not evaluated properly.The aim of this study was to review literature on evaluation andtreatment of pain in pediatric emergency unit.Methods: A search from Cinahl and Finnish Medic-databasecovering last 10 years was performed using: pain, child, trauma,documentation, evaluation, emergency and assessment as keywords.Results: Multiple pain scales are used in pediatric emergencyunits. A scale possibly useful for us is the CEM, College of Emergency Medicine tool. Non-medical procedural pain treatment:physical methods (e.g. cold, warm, massage), emotional supportand cognitive-behavioral methods (e.g. relaxation, mental imageryand information) was found to be as useful in children. The aimof cognitive-behavioral methods is to decrease fear, stress andpain and improve self-determination. Non-medical treatment wasfound to be cost efficient and decrease the need of analgesics. It wasalso found that a child in pain should be raised in triage. Educatedstaff usually means that children get pain medication quicker.Conclusions: Research on the effects of systematic use of a painscales on pain treatment, pain and fear in pediatric patients wouldbe interesting.http://dx.doi.org/10.1016/j.sjpain.2013.07.009B2Proteomic analysis of cerebrospinal fluid givesinsight into the pain relief of spinal cordstimulationAnne-Li Lind 1,2 , Magnus Wetterhall 1 , MarcusSjödin 1 ,Torsten Gordh 21Analytical Chemistry, Department ofChemistry-BMC, UppsalaUniversity, Sweden2 Department of Surgical Sciences, Pain Research,Uppsala University, SwedenAims: Neuropathic pain is caused by a lesion or disease of thesomatosensory nervous system affecting approximately 2% of thepopulation. Current pharmacological treatments are ineffective formore than 50% of the patients and often give much adverse effects.Spinal cord stimulation (SCS) is an alternative cost-effective treatment with high efficacy, prolonged pain relief, few side effects.We have compared the cerebrospinal fluid (CSF) proteomes fromneuropathic pain patients during pain relief induced by SCS andduring pain sensation without SCS, to gain further insights into themechanisms behind the obtained analgesia.Methods: Paired CSF samples were taken from SCS-responsiveneuropathic pain patients after the SCS had been turned off for 48 hand when the SCS had been used normally for three weeks. Thus,each patient acted as their own control. The corresponding pro- http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

A pediatric patients’ pain evaluation in the emergency unit

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de Gruyter
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© 2013 Scandiavian Association for the Study of Pain
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1877-8860
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1877-8879
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10.1016/j.sjpain.2013.07.009
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Abstract

Poster-abstracts from SASP 2013 / Scandinavian Journal of Pain 4 (2013) 255–260to improve the pain management practices in the hospital, with aninitial emphasis on pain assessment.http://dx.doi.org/10.1016/j.sjpain.2013.07.007A6Promising effects of donepezil when added topatients treated with gabapentin forneuropathic painA. Basnet 1 , S. Butler 2 , P. Hartvig Honoré 1 , M.Butler 2 , T.E. Gordh 2 , K. Kristensen 3 , O.J.Bjerrum 11 Department of Drug Design and Pharmacology,University of Copenhagen, Denmark2 Multidisciplinary Pain Centre, Uppsala UniversityHospital, Sweden3 Novo Nordisk A/S, Måløv, DenmarkAims: The clinical relevance of adding the acetylcholinesteraseinhibitor donepezil to existing gabapentin treatment in patientswith post-traumatic neuropathic pain was explored in this openlabel study. The two drugs have previously shown synergismfollowing co-administration in nerve-injured rats [1,2].Methods: The study comprised two consecutive periods of minimum six weeks: (1) titration of gabapentin until highest tolerabledose or maximum 2400 mg daily; and (2) addition of donepezil5 mg once daily to the fixed gabapentin dose. Efficacy and tolerability were assessed by ratings of pain intensity, questionnairesfor pain and health-related quality of life, and reporting of adverseevents and analgesic rescue medication. Pain scores were also analyzed using mixed-effects analysis (i.e. incorporating inter-subjectvariability) with the software NONMEM.Results: Eight patients commenced treatment with donepezilupon the gabapentin titration period, of which two withdrew dueto adverse events. Addition of donepezil reduced pain by >35% infour of six patients compared to gabapentin monotherapy. Mixedeffects analysis revealed that pain scores were significantly lowerduring co-administration (p < 0.05 combination vs. monotherapy).Donepezil was well tolerated in combination with gabapentin. Atthe end of study, three patients wished to continue combinationtherapy with gabapentin and donepezil.Conclusion: Donepezil may provide additional analgesia to neuropathic pain patients with insufficient pain relief from gabapentinas monotherapy. Further confirmation in controlled clinical trialsis justified. Mixed-effects analysis was sensitive enough to detectstatistically significant effects, showing its usefulness in small-scaletrials and/or when data is associated with high variability.References[1] Folkesson A, Hartvig Honoré P, Munkholm Andersen L, Kristensen P, Bjerrum OJ.Low dose of donepezil improves gabapentin analgesia in the rat spared nerveinjury model of neuropathic pain: single and multiple dosing studies. J NeuralTransm 2010;117:1377–85.[2] Hayashida K, Parker R, Eisenach JC. Oral gabapentin activates spinal cholinergiccircuits to reduce hypersensitivity after peripheral nerve injury and interactssynergistically with oral donepezil. Anesthesiology 2007;106:1213–9.http://dx.doi.org/10.1016/j.sjpain.2013.07.008257A7A pediatric patients’ pain evaluation in theemergency unitAnette LemströmHelsinki University Central Hospital, Hospital forChildren and Adolescents, Helsinki, FinlandAims: Helsinki University Hospital for Children and Adolescentstreats 0- to 16-year old pediatric and surgical patients. The patientsarrive to the emergency unit by ambulance, referral or by decision of the triage nurse. The most common reason for visit is pain.VAS pain scale should be used, but pain is not evaluated properly.The aim of this study was to review literature on evaluation andtreatment of pain in pediatric emergency unit.Methods: A search from Cinahl and Finnish Medic-databasecovering last 10 years was performed using: pain, child, trauma,documentation, evaluation, emergency and assessment as keywords.Results: Multiple pain scales are used in pediatric emergencyunits. A scale possibly useful for us is the CEM, College of Emergency Medicine tool. Non-medical procedural pain treatment:physical methods (e.g. cold, warm, massage), emotional supportand cognitive-behavioral methods (e.g. relaxation, mental imageryand information) was found to be as useful in children. The aimof cognitive-behavioral methods is to decrease fear, stress andpain and improve self-determination. Non-medical treatment wasfound to be cost efficient and decrease the need of analgesics. It wasalso found that a child in pain should be raised in triage. Educatedstaff usually means that children get pain medication quicker.Conclusions: Research on the effects of systematic use of a painscales on pain treatment, pain and fear in pediatric patients wouldbe interesting.http://dx.doi.org/10.1016/j.sjpain.2013.07.009B2Proteomic analysis of cerebrospinal fluid givesinsight into the pain relief of spinal cordstimulationAnne-Li Lind 1,2 , Magnus Wetterhall 1 , MarcusSjödin 1 ,Torsten Gordh 21Analytical Chemistry, Department ofChemistry-BMC, UppsalaUniversity, Sweden2 Department of Surgical Sciences, Pain Research,Uppsala University, SwedenAims: Neuropathic pain is caused by a lesion or disease of thesomatosensory nervous system affecting approximately 2% of thepopulation. Current pharmacological treatments are ineffective formore than 50% of the patients and often give much adverse effects.Spinal cord stimulation (SCS) is an alternative cost-effective treatment with high efficacy, prolonged pain relief, few side effects.We have compared the cerebrospinal fluid (CSF) proteomes fromneuropathic pain patients during pain relief induced by SCS andduring pain sensation without SCS, to gain further insights into themechanisms behind the obtained analgesia.Methods: Paired CSF samples were taken from SCS-responsiveneuropathic pain patients after the SCS had been turned off for 48 hand when the SCS had been used normally for three weeks. Thus,each patient acted as their own control. The corresponding pro-

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Scandinavian Journal of Painde Gruyter

Published: Oct 1, 2013

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