English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

SUBSEQUENT to reports regarding selfadministered inhalational labour analgesia in the late 1940s,1 theories of operant behaviour were applied to the paradigm, now known as patient-controlled analgesia (PCA), for the measurement and treatment of pain.2,3 This subject ignited a fascinating area of pain research and the clinical development of PCA,4 which is currently the most common treatment strategy for postoperative pain.5 Patient-controlled analgesia requires the patient to activate a delivery system (PCA demand) to repeatedly administer an analgesic drug dose (bolus), so as to maintain maximal comfort, but not more frequently than a specified time interval (lockout), so as to minimize toxicity.4 Despite its apparent simplicity, the PCA paradigm has stimulated extensive inquiry in the form of over 2,700 publications, 1,100 clinical trials, and 250 review articles addressing analgesic pharmacology, medical device technology, and most importantly, the treatment and behaviour of persons in pain. In this issue of the Journal, Katz et al.6 describe psychometric indicators which appear to predict a higher frequency of PCA demands for morphine following gynecological surgery. Secondary analyses from a previous clinical trial7 examined associations between 48 hr cumulative “locked out” PCA demands and pain, and morphine consumption and several preoperative psychometric indicators of negative affect, such as anxiety and avoidant behaviours, or intrusive thoughts regarding anticipated surgery.6 Based on evidence that intrusive thoughts (e.g., pain anticipation) impact upon psychological distress and subsequent analgesic demands, Katz et al.6 used path analysis8 to demonstrate that avoidant behaviours/intrusive thoughts about upcoming surgery were positively correlated with PCA lockout demands.6 These findings are consistent with, and expand upon, previous study results, such as those from Jamison et al.,9 which suggested significant correlations between PCA dose/demand ratio and preoperative measures of emotional distress. Although PCA demands are obviously linked to pain intensity and analgesic consumption, understanding other determinants of PCA lockout demands might explain some of the complexities of pain behaviour.

L’analgésie contrôlée avec patience: vers une meilleure compréhension des comportements d’auto-administration des analgésiques