Acupuncture recovery femur break1/22/2024 ![]() In this report, two CAM practices were identified as having been used with hip fracture patients: acupressure and the Jacobson relaxation technique.Īccording to traditional Chinese acupuncture, auricular acupressure involves the placing of tiny beads onto the outer ear at acupuncture points, thereby stimulating the corresponding acupuncture points. 21 CAM practices are often grouped into broad categories, such as natural products, mind-body medicine, and manipulative and body-based practices. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses). market in the 1990s with the current use of coxibs in decline.Ĭomplementary and Alternative Medicine (CAM)Ĭomplementary and alternative medicine ( CAM) has been defined as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine (i.e., medicine as practiced by holders of M.D. The use of COX-II selective inhibitors (coxibs) has fluctuated since their introduction on the U.S. 20 Acetaminophen, a commonly used analgesic, has minimal inhibition of COX-1 and COX-2, with appreciable inhibition of central COX-3, but its precise mechanism for analgesia has not been confirmed. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., diclofenac) are used for their analgesic properties and act by inhibiting both cyclooxygenase (COX) isoenzymes (COX-1 and COX-2). Sufentanil is 5–10 times more potent than fentanyl and, due to its immediate onset of action and its limited accumulation, it is ideal for short, quick action. 19 Fentanyl, primarily targets the mu receptors in the brain and spinal cord and, is used in the treatment of severe pain. Opiates (e.g., morphine) can be used at all stages of pain management to treat mild to severe pain. The general goal is to provide pharmacologic analgesia although some also have anti-inflammatory properties. This classification of intervention is broad and encompasses both narcotic and non-narcotic medications. Postoperative pain management is usually accomplished by a more diverse array of interventions including systemic analgesia, nerve blocks, physical therapy, and transcutaneous electrical nerve stimulation ( TENS). Even so, neuraxial anesthesia is gaining momentum as a replacement for general anesthesia. Intra-operative pain management has also traditionally been achieved with systemic analgesia in association with general anesthesia. Recently, nerve blocks, which block the nerve impulses from reaching the sensory cortex, have been introduced. Therefore the interventions administered to relieve pain in this population can be divided according to both the timing of the intervention (e.g., pre-, peri-, and postoperative) and according to their classification (e.g., systemic analgesia, nerve blocks, etc.).Īccording to the timing of the intervention, preoperative pain management has traditionally been achieved using systemic analgesia and in some cases, lower limb traction. Hip fracture patients require a continuum of pain management from the time of prehospital admission through the completion of final rehabilitation. Furthermore, poorly managed postoperative pain is associated with delayed ambulation, pulmonary complications, and delayed transition to lower levels of care. 15-17 Therefore, it is important to treat and manage complaints of pain adequately during acute treatment for hip fracture. Pain following hip fracture has been associated with delirium, depression, sleep disturbance, and decreased response to interventions for other disease states. ![]() 10, 11 Because of poor functional recovery, health service utilization associated with recovery is substantially increased for at least 1 year, with much of the health care cost attributable to subsequent long-term care. 9 Up to 25 percent of hip fractures occur in continuing care facilities (long-term residential care for dependent people). 5 Furthermore, a large proportion of those patients who survive never recover to their prefracture level of function, 6-8 and approximately 25 to 50 percent of elderly patients with hip fractures have not returned home by 1 year postfracture. Short-term mortality rates are high and range from 25 percent for women to 37 percent for men in the first year following a hip fracture. ![]() 1-4 The impact of hip fractures is far reaching. Incidence increases substantially with age, rising for men and women, respectively, from 22.5 and 23.9 per 100,000 population at age 50, to 630.2 and 1,289.3 per 100,000 population by age 80. ![]() Hip fractures are a source of significant morbidity and mortality.
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