A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients.

BACKGROUND: Adequacy of pain management is a process indicator of health care quality with consequences for patient outcomes and satisfaction. The reported incidence of moderate to severe postoperative pain worldwide is between 20% and 80%. OBJECTIVES: The purpose was to assess the quality of pain management in a cohort of Danish postoperative patients by examining their pain experience, beliefs about pain and pain treatment, and relationships between pain intensity, its effect on function, and pharmacological pain management. METHODS: The American Pain Society's Patient Outcome Questionnaire was administered to a consecutive cohort of Danish patients who had undergone gastrointestinal, gynaecological, orthopaedic or urological surgery within 24 and 72 h of surgery. RESULTS: Findings indicated uncontrolled pain in 45.5% of patients. These patients reported moderate to severe intensity average pain in the previous 24 h, however, 88.4% of the cohort overall stated they were satisfied or very satisfied with pain treatment. Patients who experienced severe pain only received 50% of available strong opioids, 73.3% of available weak opioids, 100% of available non-steroidal antiinflammatory drugs (NSAIDS) and paracetamol. Further, analgesics prescribed to be administered at fixed intervals were administered 99% of the time; in contrast, all Pro Re Nata (PRN) orders irrespective of analgesic categories, were administered only 25% of the time. CONCLUSIONS: A number of patients experienced significant pain postoperatively. Although multi-modal analgesics were available, analgesic administration practices did not consistently reflect management responsive to patient needs. Despite this, patients were largely satisfied with the care received suggesting the need for further research to understand how patients perceive the efficacy of pain management.

Immunoglobulin treatment versus plasma exchange in patients with chronic moderate to severe myasthenia gravis.

The purpose of this study was to compare the efficacy of high-dose intravenous immunoglobulin (IVIG) treatment with plasma exchange in patients suffering from moderate to severe myasthenia gravis (MG) in a stable phase. There are no controlled studies comparing IVIG with plasma exchange in patients who despite immunosuppressive treatment have persistent incapacitating MG symptoms. This was a controlled crossover study. Twelve patients with generalized moderate to severe MG on immunosuppressive treatment for at least 12 months were included. The patients were evaluated clinically using a quantified MG clinical score (QMGS) before and at follow-up visits after each treatment. One week after the treatments, the patients who received plasma exchange treatment showed a significant improvement in QMGS compared to baseline but although some improvement was seen after IVIG this did not reach statistical significance. Four weeks after both plasma exchange and IVIG treatments, there was a significant improvement in QMGS compared to baseline. One week and 4 weeks after treatment, no significant difference between the 2 treatments was found. Both treatments have a clinically significant effect 4 weeks out in patients with chronic MG, but the improvement has a more rapid onset after plasma exchange than after IVIG.