Medicine and Health Sciences Commons^™

Pectoralis Nerve Block Compared To Thoracic Paravertebral Nerve Block In The Mastectomy Patient: Evidence-Based Practice Recommendations, Eric Boyer

Doctor of Nursing Practice Scholarly Projects

Patients undergoing a mastectomy are at increased risk of becoming opioid dependent. Most patients undergoing a mastectomy are diagnosed with breast cancer, and the use of opioids is known to aid in cancer metastasizing due to the suppression of the body's natural killer cells. In addition, regional anesthesia, also known as a nerve block, has long provided a reduction in sensation by blocking the nerve pathway, thus numbing the feeling of pain in the operative area. The Pectoralis nerve block (PECS) and the Thoracic Paravertebral block (TPVB) are used in patients undergoing a mastectomy to help reduce the severity of …

Mesenchymal Stem Cell Use In The Treatment Of Osteoarthritis: A Literature Review, Samantha Arrizon, Nolan Barnes, Teresa Del Toro, Lei Wena Herme, Vanessa Mendoza, Thi Tran, Reeta Zamro

Physician Assistant Studies | Literature Reviews

Mesenchymal stem cell (MSC) therapies have been growing in popularity in research due to their anti-inflammatory, immunomodulatory, and regenerative properties. Many ongoing clinical trials are investigating the safety and efficacy of MSC therapies to treat osteoarthritis, also known as “wear and tear” arthritis. As the average life expectancy increases, with age people are more prone to developing this disease, therefore, increasing its prevalence. This condition is progressive and will lead to functional decline, decreased quality of life, and increased medical costs. Our focus is to discuss the efficacy of mesenchymal stem cell injections in alleviating pain, improving functionality, and slowing …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Factors Influencing Nurses’ Willingness To Recommend Reiki For Their Oncology Patients’ Pain, Amy Nezzer

Walden Dissertations and Doctoral Studies

Hospitalized, adult, oncology patients experience intractable pain that does not always respond to pharmacological therapies. Reiki is a complementary and alternative method used to reduce pain and increase the effectiveness of pharmacological treatments, but nurses may not possess knowledge about Reiki or have the self-efficacy to educate patients about Reiki. The purpose of this study, guided by Bandura’s social cognitive theory, was to identify the relationship between nurses’ knowledge, level of self-efficacy in educating their patients, beliefs about Reiki’s effectiveness, years practicing as a nurse, and willingness to recommend Reiki for their oncology patients’ pain. The Knowledge of Nurses’ Questionnaire …

Guided Imagery And Sentinel Lymph Node Biopsy Pain, Brandy Alicia Kirk

Evidence-Based Practice Project Reports

The standard of care in the treatment for women diagnosed with breast cancer includes identification and biopsy of the sentinel lymph nodes (SLN) of the breast (Chaterjee et al., 2017; Kneece, 2017). The process of identifying the SLNs involves radioisotope injections into or near the areola. Because this area is highly sensitive, women report this procedure to be considerably painful. The purpose of this evidence-based practice (EBP) project was to determine if the provision of a 5-minute session of guided imagery (GI), as a complementary alternative medicine, prior to SLN injections was effective in mitigating reports of procedural pain. A …

Chronic Pain, Malingering, And The Word Memory Test, Dawn Marie Emmett Bishop

Walden Dissertations and Doctoral Studies

AbstractThe importance of using scientifically grounded strategies to detect malingering has been established in the literature and past research. Many reliable tools have been established for the detection of malingered neurocognition; however, research on how pain may affect these tools is sparse. The purpose of this study was to investigate the effect of pain on cognitive symptom validity testing and to establish the validity of the Word Memory Test (WMT), a cognitive symptom validity test with good sensitivity and specificity, when the test taker is feigning pain (simulating) or remembering pain. The biopsychosocial model and the gate theory of pain …

Comparison Of Non-Nsaid Pain Management In The Treatment Of Patients With Symptomatic Knee Osteoarthritis, Nicholas Schmitz

Theses and Graduate Projects

Objective To compare the efficacy of other modalities and interventions versus standard first-line therapy of nonsteroidal anti-inflammatory drugs for pain management in patients with symptomatic knee osteoarthritis

Methods Perform literature reviews outlining patients suffering from Grade II or higher KOA using the Kellgren-Lawrence classification system and currently experiencing symptoms of pain, stiffness, and impaired physical functioning. Use data and results from various studies to compare improvement of symptoms from these modalities versus improvement of NSAIDs alone.

Results Weight loss and physical activity should remain the mainstay of early osteoarthritis treatment to help slow disease progression and symptoms of KOA. Duloxetine …

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that …

Is Cannabis Effective In Reducing Muscle Spasticity And Body Pain Amongst Patients With Multiple Sclerosis?, William E. Johnson

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not cannabis is effective in reducing muscle spasticity and body pain amongst patients with Multiple Sclerosis (MS).

STUDY DESIGN: A systematic review of three peer-reviewed studies published between the years of 2003 and 2012.

DATA SOURCES: Three randomized control trials (RCTs) evaluating if cannabis can reduce muscle spasticity and body pain for patients diagnosed with Multiple Sclerosis. All three sources were selected from PubMed and examined for outcomes that were patient oriented.

OUTCOMES MEASURED: The two primary outcomes measured include: muscle spasticity measured by the Ashworth scale, …

The Association Between Physiologic Sources Of Pain And Sleep Quality In Older Adults And People With Dementia, Crystal-Rae Evans

Theses and Dissertations

The association between physiologic sources of pain and sleep quality in older adults and people with dementia was examined in this dissertation. Previous research illustrates multiple factors contribute to sleep quality outcomes. Musculoskeletal pain, respiratory distress, gastrointestinal discomfort, and genitourinary pain were examined in relation to sleep quality in older adults and people with dementia. No theory currently exists to guide this nursing research, therefore an illustration of pain and sleep quality in older adults and people with dementia was utilized. Descriptive data analysis and logistic regression were used to address the study aims. The findings from this research illustrate …

Is Preoperative Administration Of Celecoxib And Pregabalin Associated With Decreased Intraoperative And Postoperative Opioid Consumption In Patients Undergoing Total Hip Or Knee Arthroplasty?, Cierra Treadway

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to determine if a preoperative dose of celecoxib and pregabalin in patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) was associated with less opioid consumption intraoperatively and postoperatively compared to those who did not receive this regimen.

Introduction: THA and TKA have been associated with a high incidence of postoperative pain. Historically, this pain has been managed with opioids; however, these drugs have negative side effects associated with their use. Consequently, anesthesia providers have begun utilizing multimodal non-opioid analgesics. Recently, a specific combination has been utilized, which includes a …

Acute Post-Operative Pain Management: Preventing Overuse Of Opioids, Alison Hirsch

Theses and Graduate Projects

Background: Surgical pain management with opioids is common. The use of multimodal analgesia has been proposed in order to provide opioid-sparing regimens and improve pain control post-operatively. Inadequate control of surgical pain can lead to development of chronic pain. Furthermore, studies have linked acute surgical opioid use to increased risk of long-term use. Long-term opioid use has undesirable, life-altering consequences, including physical dependence and addiction which may lead to overdose or death. Use of a variety of medications in the operative setting can lead to synergistic or additive effects on pain control, thus decreasing post-operative opioid consumption.

Methods: A literature …

Are Tart Cherry Supplements Effective On Reducing Muscle Soreness And Perception Of Pain In Young, Healthy Males Following High Intensity Resistance Training?, Alyssa Davis

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not tart cherry supplements are effective at alleviating muscle soreness and pain following high resistance training.

STUDY DESIGN: Review of two double blind randomized control trials, and one crossover randomized control trial. All three studies were published in English between 2006-2015.

DATA SOURCES: Two double blind randomized control trials and one crossover randomized control trial found using Cochrane and PubMed.

OUTCOMES MEASURED: The outcomes measured were muscle soreness and perception of pain. They were measured using a pressure-pain threshold and 10 point pain …

Is Weight Loss An Effective Treatment Of Pain Symptoms Related To Knee Joint Osteoarthritis In Obese Adults?, Samantha Sokol

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not weight loss is an effective treatment of pain symptoms related to knee joint osteoarthritis in obese adults.

Study Design: Systematic review of 2 randomized-controlled trials and 1 cohort study. All three articles were published in English between 2011-2015.

Data Sources: Two randomized, un-blinded, controlled studies and one cohort found using Pubmed.

Outcomes Measured: Each study evaluated change in pain symptoms related to knee osteoarthritis in obese adults as compared to weight loss.

Results: Studies showed that weight loss lead to a …

Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance

Doctoral Projects

Roughly 100 million surgical procedures are performed in the United States (U.S.) each year and more than 80% of these patients experience acute postoperative pain. Pain costs the U.S. an estimated $560 to $635 billion annually and is a significant contributor to national rates of mortality, morbidity, and disability. Despite these findings, patients continue to receive suboptimal postoperative pain relief.

The adjunct administration of subanesthetic ketamine is opioid-sparing and can improve the effectiveness of a multimodal pain management approach. This project used an exploratory descriptive design to examine how an evidence-based presentation impacted the clinical practice of certified registered nurse …

The Association Between Intraoperative Single-Dose Dexamethasone And Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy, Sara Hatfield

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to examine the association between a single dose of intraoperative dexamethasone in patients undergoing outpatient laparoscopic cholecystectomy surgery and postoperative pain scores and the amount of postoperative opioid administration.

Introduction: Pain is one of the most common complaints in the postoperative period and the days following a patient’s procedure. While opioids are commonly used for treating intraoperative and postoperative pain, anesthesia providers can lessen their use by adopting multimodal analgesia techniques. This study attempts to fill the research gap related to the association of a single dose of intravenous dexamethasone intraoperatively …

The Association Of Nurses’ Assessment And Certainty To Pain Management And Outcomes For Nursing Home Residents In Jordan, Mohammad Jamil Rababa

Theses and Dissertations

Despite advances in dementia care Pain in people with dementia is still under recognized, underestimated, and undertreated because of poor assessment, poor treatment, and factors relating to nurses’ critical thinking and decision-making skills. Unrelieved pain leads to many serious negative health outcomes in people with dementia. The purpose of the study was to examine temporally based relationships between change in behavior, the nurses’ level of certainty regarding pain, assessment scope and outcomes of pain and agitation. Relationship between severity of dementia, comorbid burden, ability to verbally self-report symptoms and patient outcomes of pain and agitation was also investigated.

A Convenient …

Adoption Of Perioperative Lidocaine Infusion For The Reduction Of Postoperative Pain, Brandon Scott Figueiredo

Doctoral Projects

Laparoscopic capability provides numerous benefits to patients requiring abdominal surgical procedures. However, the use of these techniques has presented the anesthesia provider with a unique set of challenges in terms of perioperative management and postoperative pain reduction. No standardized method has existed to reduce postoperative pain and improve recovery following these procedures. There were three primary goals of this project. The first goal was to conduct a meta-analysis of randomized controlled trials to determine the benefit of the use of intravenous lidocaine infusions to reduce postoperative pain in laparoscopic abdominal surgery. Twelve articles were included in the meta-analysis that pertained …

Evaluating The Effectiveness Of Care Choices A Home-Based Palliative Care Program, Katherine Pouliot

Honors Theses

Background: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid unnecessary hospitalizations and remain with their regular outside care providers. Objective: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine, a community healthcare system serving New York’s Capital District. Design: A prospective cohort study tracking patient outcomes over the course of one year. Subjects and setting: One hundred twenty-three patients (49 men, 74 women) with serious illnesses who were new enrollees in Care …

Factors And Outcomes Associated With Potentially Inappropriate Medication Use In Rural Community-Dwelling Older Adults, Marcia Y. Shade

Theses & Dissertations

Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), …

Recognizing Pain Using Novel Simulation Technology, Justin C. Grace

Honors Undergraduate Theses

Effective pain management and time to treatment is essential in patient care. Despite scientific evidence supporting the need to treat pain and an emphasis on addressing pain as a priority, pain management continues to be an unresolved issue. As a member of the health care team, nurses are integral to optimal pain management. Currently, nursing schools have limited innovative or alternative methods for teaching pain assessment and management. Simulation in nursing education provides a unique opportunity to expose students to realistic patient situations and allow them to learn and make mistakes without causing harm. However, modern low- and high-fidelity simulation …

The Association Between Soft Tissue Releases And Bony Resections Performed During Total Knee Arthroplasty And Patients' Pain And Satisfaction Postoperatively, Matt Carter

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a surgical treatment of degenerative knee conditions such as osteoarthritis to reduce pain and increase function. Intraoperative soft tissue releases (STRs) and bony resections (BRs) are necessary for a balanced and aligned TKA. It is possible that the degree of STRs and BRs is related to final outcome following TKA and thus there may be implications for patient rehabilitation, patient expectations, pain medications, and timelines for recovery. Thus, our primary objective was to examine the association between the number of STRs and BRs performed intraoperatively and patients’ satisfaction and pain at three months. We performed …

The Experiences Of Black American Older Adults Managing Pain: A Nursing Ethnography, Sheria Grice Robinson

Wayne State University Dissertations

Introduction: Pain can negatively affect quality of life for Black elders. They are less likely to report pain concerns and have voiced pain needs adequately met. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility. Methods: 106 participants completed a questionnaire comprised of a demographic tool, the PROMIS Global Health Scale (PROMIS), the Brief Pain Inventory (BPI), and the Psychological Stress Measure (PSM-9). Additionally, participant observation, informal interviews, and 20 formal recorded interviews with individuals identified as having pain were completed. Qualitative and frequency analysis …

Effects Of Music Intervention On The Patient’S Perception Of Pain After Knee Replacement Surgery, Heather E. Hooks

Electronic Theses and Dissertations

The purpose of this study was to determine whether therapeutic music affects the patient’s perception of pain, postoperative day 1 after knee replacement surgery in an inpatient hospital. In addition to the patient’s pain levels, the study was an analysis of the quantity of opioids the patient was requested, the length of stay, and the physiological parameters, which included blood pressure, heart rate, respiratory rate, and oxygen saturation. Sixty knee replacement patients were randomly placed in the music group or the quiet group. The Faces Pain Scale Revised with Numeric Rating Scale was used to measure pain levels. Statistical analysis …

Analysis Of Degenerative Cervical Spondylolisthesis And Corrective Orthopaedic Implants, Tyler Heck

Honors Theses

Back pain is often due to the degeneration of intervertebral discs, which can lead to a condition known as spondylolisthesis, whereby a vertebra slips out of position in the anteroposterior direction. There are numerous orthopaedic implants which are used by surgeons to correct this condition; however, there has been no conclusive research conducted in comparing the efficacies of these implants. In the cervical spine, this condition most commonly occurs over two levels. For the purposes of this study, an implant’s efficacy depends on its ability to return the slipped vertebra back into natural position immediately after surgery. To test these …

Race/Ethnicity, Subjective And Objective Sleep Quality, Physical And Psychological Symptoms In Breast Cancer Survivors, Pinky H. Budhrani

USF Tampa Graduate Theses and Dissertations

Breast cancer is a major health problem and comprises the largest population of cancer survivors in the United States, estimated at 2.9 million women, accounting for 22% of all cancer survivors (National Cancer Institute, 2013). The advances in breast cancer screening, diagnosis and treatment has increased the importance of survivorship needs. A major concern among breast cancer survivors (BCS) is sleep disturbances. This study used an innovative approach to examine ethnic and racial disparities in sleep disturbances present in BCS. In addition, this study also explored sleep disturbances across different races/ethnicities. This study was a secondary data analysis of baseline …

Is There A Benefit To Suturing Vs. Stapling In Cesarean Section Closure When Comparing Postoperative Pain And Patient Satisfaction?, Jennifer Pilchman

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE:The objective of this selective EBM review is to determine whether or not there is a benefit to suturing vs stapling in cesarean section closure when comparing postoperative pain and patient satisfaction.

STUDY DESIGN: Review of three English language primary studies published in 2009 and 2010.

DATA SOURCES: Three randomized control trials (RCTs) comparing the surgical closures for cesarean section delivery. All RCTs were found by the author using MEDLINE, PUBMED, and COCHRANE databases. They are all published articles written in English.

OUTCOME MEASURED: Outcomes were measured by assessing patient satisfaction, postoperative pain, cosmetic appearance and wound complications. Rousseau …

Is Kangaroo Care Effective In Reducing Procedural Pain In Neonates?, Sara A. Deringer-Kohorst

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this systematic review is to determine whether Kangaroo Care is effective in reducing procedural pain in neonates.

Is A Musical Intervention Effective In The Reduction Of Needle Related Procedural Pain In Children?, Heather B. Good

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE:Trypanophobia, or the fear of needles and needle pain is a very common occurrence in children, one that can have significant impacts into adulthood and on an individual’s lifelong healthcare. The objective of this systematic review is to determine whether or not a musical intervention is effective in the reduction of needle-related procedural pain in children. The author searched OVID Medline and Cochrane databases for peer-reviewed articles and systematic reviews addressing the topic, published in English after 1996. Three randomized controlled trials were selected on the basis of their being POEM’s and not included in previous systematic reviews, the results …

Expectations Of Pain Relief Utilizing Epidural Analgesia, Kelly Powell Morris

Nursing Theses and Capstone Projects

This study describes patient expectations and actual pain relief reported by patients experiencing childbirth while utilizing epidural analgesia as their method of choice to reduce the pain associated with childbirth using a quantitative descriptive design. Data were collected using the Expectations of Pain Relief Utilizing Epidural Analgesia Questionnaire. The sample (N=17) consisted of first-time mothers delivering at an acute community hospital who were participants in the county's Nurse-Family Partnership Program. The questionnaire, developed by the researcher, was distributed to participants by their Nurse-Family Partnership Registered Nurse during a routine postpartum home visit during the three month study time span. The …