title: Integrative review: postcraniotomy pain in the brain tumour patient.
abstract: OBJECTIVE
  To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥21 years of age), postcraniotomy, brain tumour patients hospitalized on intensive care units.
  
  
  BACKGROUND
  Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how postcraniotomy pain unfolds over time will help inform patient care and aid in future research and policy development.
  
  
  METHODS
  Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms' concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were 'traumatic brain injury', 'pain, post-operative', 'brain injuries', 'postoperative pain', 'craniotomy', 'decompressive craniectomy' and 'trephining'.
  
  
  METHODS
  Medline, OVID, PubMed and CINAHL databases from 2000-2014.
  
  
  METHODS
  Cooper's five-stage integrative review method was used to assess and synthesize literature.
  
  
  RESULTS
  The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Postcraniotomy brain tumour pain was well-documented and associated with nausea, vomiting and changes in blood pressure, and it impacted the patient's length of hospital stay, but there was no consensus for how best to treat such pain.
  
  
  CONCLUSIONS
  The Theory of Unpleasant Symptoms provided structure to the search. Postcraniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of postcraniotomy pain in this population.
authors.affiliation: Indiana University School of Nursing, Indianapolis, Indiana, USA.
authors.forename: Rebecca Elizabeth
authors.initials: RE
authors.lastname: Guilkey
authors.affiliation: Indiana University School of Nursing, Indianapolis, Indiana, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Von Ah
authors.affiliation: Indiana University School of Nursing, Indianapolis, Indiana, USA.
authors.forename: Janet S
authors.initials: JS
authors.lastname: Carpenter
authors.affiliation: Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stone
authors.affiliation: Indiana University School of Nursing, Indianapolis, Indiana, USA.
authors.forename: Claire B
authors.initials: CB
authors.lastname: Draucker
mesh_terms: D000328:Adult; D001930:Brain Injuries; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009325:Nausea; D010146:Pain / Q000209:etiology*
keywords: brain tumour; craniotomy; integrative review; literature review; nurses; nursing; pain; theory of unpleasant symptoms