Robert Daoust

Re: KD Craig. Knowledge Translation and the Science of Pain. Pain Res Manage 2008;13(6):464

Children with intellectual and developmental disabilities suffer more often from pain than their typically developing peers. Their pain can be difficult to manage, and assessment is often complicated by their limited communication skills, multiple complex pain problems and the presence of maladaptive behaviours. However, current research does provide some guidance for assessing their pain. Although self-report is an alternative for a small number of higher-functioning children, observational measures have the most consistent evidence to support their use at this time. For this reason, the Non-communicating Children&#x2019;s Pain Checklist &#x2013; Postoperative Version is recommended for children and youth 18 years of age or younger. However, other measures should be consulted for specific applications. Changes in function and maladaptive behaviour should also be considered as possible reflections of pain. In addition, children&#x2019;s coping skills should be considered because improving these may reduce the negative impact of pain.

Lynn M Breau

Chantel Burkitt

Assessing Pain in Children with Intellectual Disabilities

Chronic pain is an escalating public health problem. There are inadequate resources to assist patients suffering with pain in Canada. Therefore, it is important that research examining novel and appropriate treatment for chronic pain is conducted. To determine the current level of research funding for pain in Canada, the Canadian Pain Society conducted a survey. Of 79 active researchers performing pain-related studies, 65 received funding in the past five years amounting to a total of approximately $80.9 million. This is less than 1% of the total funding from the Canadian Institutes of Health Research and 0.25% of the total funding for health research.

Mary E Lynch

Donald Schopflocher

Paul Taenzer

Caitlin Sinclair

Research Funding for Pain in Canada

BACKGROUND: Nitroglycerin (NTG) has been shown to be a useful adjunct for pain treatment without increasing adverse side effects. The effects of NTG on postoperative morphine consumption after knee replacement were evaluated.METHODS: After undergoing total knee replacement, patients receiving patient-controlled morphine analgesia were randomly assigned to receive either an NTG or a placebo patch. The blinded investigator assessed each patient using a visual analogue scale at rest and while moving, as well as the patient’s morphine requirements, sedation score, sleep quality, nausea and vomiting, vital signs and postoperative bleeding.RESULTS: Two of the patients in the NTG group suffered postoperative myocardial infarctions after removal of the patch. Because of these two serious adverse effects, the study was stopped prematurely. In the subset of patients studied, NTG conferred no advantage over placebo in pain control (visual analogue scale at rest or during movement) and in satisfaction scores.CONCLUSIONS: The use of NTG patches conferred no advantage over the use of placebo in patients receiving patient-controlled morphine analgesia after total knee replacement. Two myocardial infarcts occurred in this group. Therefore, the safety of postoperative NTG patch use for pain control must be questioned.

Sharon Orbach-Zinger

Artium Lenchinsky

Lesley Paul-Kesslin

Steven Velks

Moses Salai

Leonid A Eidelman

Transdermal Nitroglycerin as an Adjuvant to Patient-Controlled Morphine Analgesia after Total Knee Arthroplasty

OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.DESIGN: Ten patients 70 years of age or older undergoing either total knee (n=7) or total hip (n=3) arthroplasty were treated prospectively. Each patient received two tablets of tramadol/acetaminophen (Tramacet; Janssen-Ortho Inc, Canada) preoperatively and every 6 h postoperatively, as well as a naloxone infusion started preoperatively at 0.25 μg/kg/h and continued up to 48 h postoperatively. In addition, standard intraoperative care was provided with 0.2 mg of intrathecal morphine, 1.4 mL of 0.75% bupivacaine, and an intra-articular infiltration of 100 mL of 0.3% ropivacaine and 30 mg of ketorolac, as well as standard postoperative morphine via patient-controlled analgesia orders and celecoxib 200 mg twice daily for five days.OUTCOME MEASURES: Compared with seven historical controls, also 70 years of age or older, who had undergone either a total knee (n=4) or total hip (n=3) arthroplasty, postoperative opioid use was reduced by 80%. Except for transient nausea and vomiting in 40% and 20% of patients, respectively, the 10 patients on tramadol/acetaminophen and naloxone tolerated the new regimen without difficulty.CONCLUSION: Consequently, a randomized, double-blinded clinical trial comparing standard therapy versus standard therapy plus these two drugs seems warranted. In such a trial, it would require approximately 20 subjects per treatment arm to detect a 80% decrease in morphine use.

Ngozi N Imasogie

Sudha Singh

James T Watson

Debbie Hurley

Patricia Morley-Forster

Ultra Low-Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

Patrick J McGrath

Margot Latimer

G Allen Finley

Christine T Chambers

Measurement of Pain in Children

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<p>Pain Research and Management publishes research focusing on laboratory and clinical findings in the field of pain research and the prevention and management of pain.</p>


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<p>Chief Editor&nbsp;Professor Valeriani specialises in clinical neurophysiology with a particular interest in pain and headaches in children and adults, and is currently a neurologist who works at the Bambi Gesu Children’s Hospital in Rome.</p>


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Pain Research and Management - Table of contents 2009

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Pain Research and Management publishes research focusing on laboratory and clinical findings in the field of pain research and the prevention and management of pain.

Pain Research and Management