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Sethi V, Anand C, Della Pasqua O. Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives. Pain Ther 2024; 13:391-408. [PMID: 38662319 PMCID: PMC11111648 DOI: 10.1007/s40122-024-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
The multifaceted nature of osteoarthritis (OA) pain presents a challenge in understanding and managing the condition. The diverse pain experiences, progression rates, individual responses to treatments, and complex disease mechanisms contribute to heterogeneity in the clinical studies outcomes. The lack of a standardized methodology for assessing and classifying OA pain challenges healthcare practitioners. This complicates the establishment of universally applicable protocols or standardized guidelines for treatment. This article explores the heterogeneity observed in clinical studies evaluating OA pain treatments, highlighting the necessity for refined methodologies, personalized patient categorization, and consistent outcome measures. It discusses the role of the multidimensional nature of OA pain, underlying pain mechanisms, and other contributing factors to the heterogeneity in outcome measures. Addressing these variations is crucial to establishing a more consistent framework for evidence-based treatments and advancing care of the patient with OA pain.
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Affiliation(s)
- Vidhu Sethi
- Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore.
| | - Chetan Anand
- Advanced Pain Management Centre, Hackettstown, NJ, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, UK
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2
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Dreesmann NJ, Jung W, Shebaili M, Thompson HJ. Kidney Donor Perspectives on Acute Postoperative Pain Management. Clin Nurs Res 2023; 32:1124-1133. [PMID: 36912100 DOI: 10.1177/10547738231156151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This study employed a qualitative descriptive approach to examine living kidney donor's experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study. Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor's experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor's past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain. Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor's motivation might mediate their pain experience is needed.
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Mohammed RS, Boateng EA, Amponsah AK, Kyei-Dompim J, Laari TT. Experiences of family caregivers of people with spinal cord injury at the neurosurgical units of the Komfo Anokye Teaching Hospital, Ghana. PLoS One 2023; 18:e0284436. [PMID: 37083720 PMCID: PMC10121035 DOI: 10.1371/journal.pone.0284436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) often leaves affected persons with a lifelong demand for care. As a result, the effect of the condition goes beyond the injured person to affect family members and significant others who have to adjust their lives to provide care and support. However, little is known about the experiences of these family caregivers regarding the care of people with SCI in Ghana. Exploring their experiences would enhance the understanding of family caregiving of people with SCI and contribute to policy intervention. METHODS This qualitative descriptive phenomenology study used the purposive sampling method to select 10 family caregivers. Data were collected using a semi-structured interview guide through individual in-depth interviews. Written informed consent was obtained and interviews were audio-recorded and transcribed verbatim. Data were manually analysed following Colaizzi's method of data analysis. RESULTS In all, 4 main themes emerged from the analysis of data (1) becoming a caregiver, (2) roles of the caregiver, (3) the burden of caregiving, and (4) coping strategies. The family caregivers provided vital assistance to their relatives with SCI and experienced physical and financial burdens as a result of the care. Due to the strains involved in the caregiving process, family caregivers adopted various strategies to cope with the situation. CONCLUSION This study has provided evidence of the lived experiences of family caregivers of people with SCI in the Ghanaian context and further supports the findings of previous studies. Measures including training, counselling, and instituting social support services for family caregivers should be considered by the management of healthcare institutions to enhance the experiences of family caregivers.
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Affiliation(s)
- Rumana Saeed Mohammed
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Edward Appiah Boateng
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Kusi Amponsah
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joana Kyei-Dompim
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Timothy Tienbia Laari
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Presbyterian Primary Health Care (PPHC), Bolgatanga, Ghana
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4
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Govas P, Ketchum A, Kazi R, Gordon BR, Carroll BT. Pain Intensity Assessment Scales for Dermatologic Surgery Patients: A Systematic Review. Dermatol Surg 2022; 48:232-238. [PMID: 34923536 DOI: 10.1097/dss.0000000000003353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain assessment plays an important role in dermatologic surgery. The numeric rating scale (NRS), visual analog scale (VAS), verbal rating scale (VRS), and Faces Pain Scale (FPS) are commonly used scales for pain measurement. Conflicting evidence exists regarding the use of each. Prompt pain recognition and treatment during procedures result in higher patient satisfaction. OBJECTIVE Determine the most applicable scale for acute pain measurement in dermatologic surgery. MATERIALS AND METHODS This systematic review was performed in accordance with PRISMA-Supplemental Digital Content 4, http://links.lww.com/DSS/A976 (PROSPERO; CRD42018091058). PubMed, Cochrane, EMBASE, Scopus, and Web of Science were searched between April 24, 2018, and May 06, 2018. The search query consisted of pain, pain measurement (NRS, VAS, VRS, and FPS), and assessment/comparison. The inclusion criteria included English language literature with primary/secondary outcome objectives directly comparing ≥2 pain scales in acute pain (age: 13+). Study end points included interscale correlations, patient preferences, provider preferences, study author recommendations, and failure rates. RESULTS Eight hundred seven studies were retrieved: A total of 42 studies were included. The visual analog scale (n = 42) was most studied, followed by NRS (n = 29), VRS (n = 27), and FPS (n = 11). 93.1% studies showed a high statistical correlation between VAS and NRS. Patients preferred NRS (n = 8/11), followed by FPS (n = 3/11), VRS (n = 2/11), and VAS (n = 1/11). Study authors recommended NRS/VAS (n = 8/19), VRS (n = 6/19), and FPS (n = 1/19). Providers preferred NRS (n = 2/3) and VRS (n = 1/3). The visual analog scale had the highest failure rate (n = 11/12). CONCLUSION The numeric rating scale is most applicable for dermatologic surgery because of reported patient and provider preferences, lowest failure rates, and most frequent study author recommendations.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea Ketchum
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rashek Kazi
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Beth R Gordon
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, Ohio
- Department of Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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5
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Boring BL, Walsh KT, Nanavaty N, Ng BW, Mathur VA. How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others' Use of Numerical Pain Scales. Front Psychol 2021; 12:663890. [PMID: 34282355 PMCID: PMC8285731 DOI: 10.3389/fpsyg.2021.663890] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.
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Affiliation(s)
- Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Kaitlyn T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Brandon W Ng
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States.,Texas A&M Institute for Neuroscience, College Station, TX, United States
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Kwekkeboom K, Serlin RC, Ward SE, LeBlanc TW, Ogunseitan A, Cleary J. Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis. Pain 2021; 162:1840-1847. [PMID: 33337597 PMCID: PMC8119296 DOI: 10.1097/j.pain.0000000000002173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Patient fear of addiction is a well-documented barrier to the use of analgesic medications for cancer pain control. Over the past 2 decades in the United States, an "opioid crisis" has arisen, accompanied by risk messages delivered through news outlets, public health education, and patient-provider communication. The purpose of this study was to determine if patient-related barriers to cancer pain management-specifically, fears of addiction-and related pain outcomes (pain severity, pain interference with daily life, and adequacy of pain management) have worsened over the last 20 years. A sample of 157 outpatients with active recurrent or active metastatic cancer completed the Barriers Questionnaire-II (BQ-II) and measures of pain and analgesic use. We identified 7 comparison studies published between 2002 and 2020 that reported patient-related barriers using the BQ-II. Significant linear relationships were found between later year of publication and greater fear of addiction (harmful effect subscale score, B = 0.0350, R2 = 0.0347, F1,637 = 23.19, P < 0.0001) and between year of publication and more pain management barriers overall (total BQ-II score, B = 0.039, R2 = 0.065, F1,923 = 73.79, P < 0.0001). Relationships between BQ-II scores (harmful effect and total) and pain outcomes did not change over time. Despite worsening in patient-related barriers, the proportion of patients with adequate vs inadequate analgesic use did not differ over time. Notably, 40% of participants reported inadequate analgesic use, a statistic that has not improved in 20 years. Additional research is necessary to clarify factors contributing to changing beliefs. Findings indicate a continuing need for clinical and possibly system/policy-level interventions to support adequate cancer pain management.
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Affiliation(s)
- Kristine Kwekkeboom
- University of Wisconsin, Madison, School of Nursing, Madison, WI, United States
| | - Ronald C Serlin
- Emeritus, University of Wisconsin, Madison, Department of Educational Psychology, (Serlin), School of Nursing (Ward), Madison, WI, United States
| | - Sandra E Ward
- Emeritus, University of Wisconsin, Madison, Department of Educational Psychology, (Serlin), School of Nursing (Ward), Madison, WI, United States
| | | | - Adeboye Ogunseitan
- Northwestern University, School of Medicine, Evanston, IL, United States
| | - James Cleary
- Indiana University, School of Medicine, Indianapolis, IN, United States
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Chen J, Tong Y, Cheng Y, Xue Z, Liu M. Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management. PAIN MEDICINE 2020; 21:3270-3282. [PMID: 33040153 DOI: 10.1093/pm/pnaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study aimed to establish a quality indicator system for postoperative pain management and test its reliability, validity, and discrimination in China. METHODS We established a quality indicator system using the Delphi method. Further, we designed and administered a survey questionnaire in the orthopedic departments of nine hospitals, located in the Zhejiang and Jiangsu Provinces, through purposive and convenience sampling methods to examine the reliability, validity, and discrimination of the quality indicator system. RESULTS We established a quality indicator system to assess structure, process, and outcome measures of postoperative pain management using three first-level, eight subordinate second-level, and 32 subordinate third-level quality indicators. The scale-level content validity indexes of the three sections of the questionnaire, assessing structure, process, and outcomes measures, were 0.99, 0.98, and 0.98, respectively. We identified two common factors from the third section that demonstrated a cumulative variance contribution rate of 80.38% and a Cronbach's α coefficient of 0.95. The total scores and scores of the structure, process, and outcome quality indicators demonstrated statistically significant differences (P < 0.05) between the wards (N = 4) that participated in the "Painless Orthopedics Ward" quality improvement program and those (N = 5) that did not. CONCLUSIONS This quality indicator system highlights the need for multidisciplinary cooperation and process characteristics of postoperative pain management, along with interdepartmental quality comparisons. And it demonstrates acceptable reliability, validity, and discrimination; thus it may be completely or partially employed in Chinese hospitals.
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Affiliation(s)
- Jiajia Chen
- Medical College, Hangzhou Normal University, Hangzhou, China.,Department of Anesthesiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yingge Tong
- Medical College, Hangzhou Normal University, Hangzhou, China
| | - Yan Cheng
- Zhejiang Provincial People's Hospital, Hangzhou, China
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8
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Abstract
BACKGROUND Postoperative concerns after Mohs micrographic surgery (MMS) are not well characterized. OBJECTIVE To better define patient concerns and contributing characteristics in the immediate postoperative period after MMS. MATERIALS AND METHODS A standardized telephone encounter template was implemented to better assess patient concerns in the 24-hour postoperative period. A review was then performed of patients undergoing MMS from October 2016 to July 2017 to assess for the most common patient concerns and association with clinical characteristics. RESULTS We included 307 patients. Overall, 60.6% of patients reported a concern. Fifty-four percent of patients reported pain. Most pain was characterized as "a little" (67.7%). On univariate analysis, flap repairs, location on the upper extremities, and swelling were associated with higher mean postoperative pain. Tumor type was not associated with increased pain. On multivariate analyses, patients with larger defects and associated edema were statistically significantly associated with higher degrees of pain. CONCLUSION Over half of patients experience postoperative concerns after MMS, most commonly pain. The immediate postoperative period may be an optimal time to identify patient concerns allowing for reassurance or early intervention when necessary.
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9
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An exploration of the experiences of people living with painful ankle osteoarthritis and the non-surgical management of this condition. Physiotherapy 2020; 110:70-76. [PMID: 32713738 DOI: 10.1016/j.physio.2020.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) of the ankle joint is associated with life-long joint pain and disability if not appropriately managed. There is a dearth of research concerning ankle OA and the impact on those living with the condition. AIM To explore the experiences of people living with painful OA ankle and their views about the non-surgical management of this condition. DESIGN Qualitative design, using semi-structured interviews. PARTICIPANTS Nine participants, recruited from an orthopaedic clinic at a UK hospital and the general population. All had a clinical and radiographic diagnosis of OA ankle. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken to identify emerging themes. Ethical approval was obtained. RESULTS Nine semi-structured interviews were undertaken. Eight participants were male, median age=55 years (IQR=42.5-64.5). Mechanism of onset was due to trauma (falls, repeated inversion injuries or road traffic collisions) (n=7), or the effects of haemophilia (n=2). The median duration of symptoms was 2 years (IQR=1.5-10). Data saturation was achieved. Four themes were identified: CONCLUSIONS: This is the first study to explore the experiences of people with symptomatic OA ankle. Our findings suggest that those with OA ankle suffer with severe pain, which has a substantial negative impact on a person's physical and mental wellbeing. The findings of this study may be used to inform future research.
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10
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Georgsson S, Carlsson T. Pain and pain management during induced abortions: A web‐based exploratory study of recollections from previous patients. J Adv Nurs 2019; 75:3006-3017. [DOI: 10.1111/jan.14132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Susanne Georgsson
- The Swedish Red Cross University College Huddinge Sweden
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Tommy Carlsson
- Sophiahemmet University Stockholm Sweden
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
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11
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Vilīte B, Strīķe E, Rutka K, Leibuss R. Pain management in intensive care unit patients after cardiac surgery with sternotomy approach. Acta Med Litu 2019; 26:51-63. [PMID: 31281217 DOI: 10.6001/actamedica.v26i1.3956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Postoperative pain is a common problem among intensive care patients. Pain management includes pain assessment and documentation, patient care, and pharmacological treatment. Materials and methods The study used a prospective, cross-sectional design. Nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. Toronto Pain Management Inventory was used to assess nurses and the 2010 Revised American Pain Society Patient Outcome Questionnaire was used to assess the patients. A research protocol was used to document pharmacological treatment data and Visual Analog Scale (VAS) pain measurements. The pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients. Results Postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). Pain intensity had a tendency to decrease over time, from a mean VAS score of 4.66 two hours after extubation to a mean VAS score of 3.12 twelve hours after extubation. Mostly opioids (100%) and nonsteroidal anti-inflammatory drugs (NSAIDs, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. Patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses' pain knowledge was average (X = 60.6 ± 7.3%). Conclusions An individualized pain management plan requires pain documentation and ensures high patient satisfaction. Pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high.
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Affiliation(s)
- Baiba Vilīte
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Eva Strīķe
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Katrīna Rutka
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Roberts Leibuss
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
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12
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Simo SM, Siela D. Use of a depression and sleep impairment treatment guideline to improve quality of life for patients with sickle cell disease. Int J Palliat Nurs 2018; 24:246-255. [PMID: 29792764 DOI: 10.12968/ijpn.2018.24.5.246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pain in sickle cell disease (SCD) is often joined by other affective disorders such as depression and/or sleep impairment that can impact pain levels and quality of life (QoL). AIM To develop a guideline to improve the process of assessment and treatment of depression and sleep impairment in patients admitted with SCD. METHOD An interdisciplinary team used the Stetler model to create the Guideline for the Evaluation and Treatment of Depression and Sleep Impairment in Sickle Cell Disease. Patients were assessed, offered treatments and reassessed during the project period. RESULTS Both depression and QoL scores showed significant improvement by the end of the project. Significant correlations were found between pain, depression and sleep; depression, pain, sleep and QoL; sleep, pain and depression; and QoL and depression. CONCLUSIONS Interdisciplinary teams are effective in creating a guideline to assess and treat depression and sleep impairment and their effects on pain and QoL in patients with SCD.
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Affiliation(s)
- Sheran M Simo
- Coordinator of Palliative Care, Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Debra Siela
- Faculty Project Advisor, Ball State University, Muncie, Indiana, USA
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13
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Arthur J, Tanco K, Park M, Haider A, Maligi C, Dalal S, Naqvi SMA, Liu D, Bruera E. Personalized Pain Goal as an Outcome Measure in Routine Cancer Pain Assessment. J Pain Symptom Manage 2018. [PMID: 29526610 DOI: 10.1016/j.jpainsymman.2018.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is currently no universally accepted outcome measure in cancer pain management. The personalized pain goal (PPG) has been shown to be a relevant outcome measure. We examined its use in routine outpatient practice and compared it with the clinically important difference (CID, ≥2 points or 30%), a pain outcome measure frequently used in several clinical studies. MEASURES Initial and follow-up clinical information of outpatients with advanced cancer pain were retrospectively reviewed. PPG response was defined as pain ≤ PPG and CID response as ≥30% or ≥2-point decrease in pain intensity at follow-up. OUTCOMES PPG was successfully completed in 375 of 387 eligible patients (97%) with cancer pain. The median baseline PPG was three for all patients and remained unchanged at follow-up. One hundred thirty-two of 375 (35%) had a PPG response and 243 of 375 (65%) were non-responders. The odds ratio for PPG non-response was 1.01 for each milligram increase in morphine equivalent daily dose (P = 0.001), 1.46 for each point increase in the number of adjuvant analgesics (P = 0.006), 2.63 for severe pain (P = 0.002), and 2.55 for moderate depression (P = 0.006). Using PPG response as the gold standard for pain relief, the overall sensitivity and specificity of CID response were 83% and 77%, respectively. CONCLUSION PPG was successfully completed in the vast majority of patients, suggesting its feasibility as a pain outcome measure in routine clinical practice. Higher baseline pain intensity, depression, opioid dose, and number of adjuvant analgesics were independent predictors of poor pain relief. Further research is needed to further evaluate its clinical importance in cancer pain management.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ali Haider
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney Maligi
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shalini Dalal
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed M A Naqvi
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Watanabe YS, Miura T, Okizaki A, Tagami K, Matsumoto Y, Fujimori M, Morita T, Kinoshita H. Comparison of Indicators for Achievement of Pain Control With a Personalized Pain Goal in a Comprehensive Cancer Center. J Pain Symptom Manage 2018; 55:1159-1164. [PMID: 29248568 DOI: 10.1016/j.jpainsymman.2017.12.476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/12/2022]
Abstract
CONTEXT The achievement of a personalized pain goal (PPG) is advocated as an individualized pain relief indicator. OBJECTIVES Pain relief indicators, including PPG, pain intensity (PI), and interference with daily activities (interference), were compared herein. METHODS This was a single-center cross-sectional study. Adult patients with cancer on opioid medications who visited the outpatient clinic at the National Cancer Center Hospital East between March and September 2015 were consecutively enrolled. Patients conducted a self-report questionnaire, including reports of average PI, interference, PPG, and the need for further analgesic treatment. We compared the proportion of patients achieving PPG (PI ≤ PPG) and other pain relief indicators including PI ≤3 or interference ≤3 and the percentage of patients who did not need further analgesic treatment among those who fulfilled each pain relief indicator. RESULTS A total of 347 patients (median age 64; 38% females) were analyzed. Median (interquartile range [IQR]) of PPG, PI, and interference was 2 (IQR 1-3), 2 (IQR 1-4), and 2 (IQR 0-5), respectively. The proportion of patients achieving PPG was 45.3% and significantly lower than those with PI ≤3 (69.0%; P < 0.001) and interference ≤3 (70.2%; P < 0.001). Eighty percent of patients achieving PPG did not need further analgesic treatment, whereas 70.8% of patients with PI ≤3 (P < 0.001) and 73.3% with interference ≤3 did need further analgesic treatment (P < 0.001). CONCLUSION The achievement of PPG was a stricter pain relief indicator than PI and interference and may reflect a real need for pain control.
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Affiliation(s)
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Ayumi Okizaki
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keita Tagami
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Maiko Fujimori
- Division of Cohort Consortium Research, Epidemiology and Prevention Group/Division of Health Care Research, QOL Research Group, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine, Tokatsu Hospital, Nagareyama, Japan
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Rau KM, Chen JS, Wu HB, Lin SF, Huang ML, Tai CJ, Hwang WL, Lu YC, Wang CC, Kuen Hsieh R. Cancer-related pain: a nationwide survey of patients' treatment modification and satisfaction in Taiwan. Jpn J Clin Oncol 2018; 47:1060-1065. [PMID: 28973687 PMCID: PMC5896696 DOI: 10.1093/jjco/hyx124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/11/2017] [Indexed: 01/05/2023] Open
Abstract
Background We have limited knowledge about cancer patients' pain control satisfaction in outpatient departments in Taiwan and doctors' practice of adjusting analgesics according to their pain status. This survey examined pain management and satisfaction among cancer outpatients with pain and obtained information on their quality of life and treatment management for different pain intensities. Methods The Short version of the Brief Pain Inventory was used as the outcome questionnaire. Participants comprised 2075 patients with different cancers and disease statuses at 14 oncological outpatient departments, of which 1051 reported pain within the week prior to testing. The impact of pain management on physical and psychological functioning, and satisfaction with doctors were evaluated. Information about doctors' prescriptions was collected. Logistic regression analyses were conducted to evaluate whether the interference scale performed identically in the different analgesic ladders. Results Pain was significantly linked to disease status and affected patients' physical and psychiatric functioning. Almost 100% of patients were satisfied with their pain control, but more than 70% of doctors did not change analgesics based on patients' current pain status. The results show that although patients were satisfied with their physicians, treatment of cancer pain was still suboptimal. Conclusion Pain assessment and treatment need to be more thorough and management guidelines should be revised to improve pain control in patients with cancer.
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Affiliation(s)
- Kun-Ming Rau
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung.,Chang Gung University, College of Medicine
| | - Jen-Shi Chen
- Chang Gung University, College of Medicine.,Division of Medical Oncology, Hematology-Oncology Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan
| | - Hung-Bo Wu
- Division of Hematology Oncology, Department of Internal Medicine, Taipei City Hospital, Renai branch, Taipei
| | - Sheng-Fung Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Ming-Lih Huang
- Division of Oncology, Department of Oncology and Cancer Study, Da Chien Hospital, Miaoli
| | - Cheng-Jeng Tai
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medicine University Hospital, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Li Hwang
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung
| | - Yin-Che Lu
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi
| | - Chuan-Cheng Wang
- Division of Medical Oncology in the Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua
| | - Ruey Kuen Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taiwan
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Older peoples' strategies for coping with chronic non-malignant pain: A qualitative meta-synthesis. Int J Nurs Stud 2016; 68:40-50. [PMID: 28073051 DOI: 10.1016/j.ijnurstu.2016.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/22/2016] [Accepted: 12/17/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies. OBJECTIVES To examine how older people cope with non-malignant chronic pain. DESIGN This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence. DATA SOURCES PubMed and Ovid Medline from 1995 to 2015. REVIEW METHODS Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. RESULTS Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: 'adjusting to the inevitable', 'doing it my way without medication' and 'the importance of support in managing the struggle'. There was high confidence in the evidence for 'doing it my way without medication' and moderate confidence in the evidence for the other two meta-themes. CONCLUSION Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required.
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Crowe M, Whitehead L, Seaton P, Jordan J, Mccall C, Maskill V, Trip H. Qualitative meta-synthesis: the experience of chronic pain across conditions. J Adv Nurs 2016; 73:1004-1016. [PMID: 27679971 DOI: 10.1111/jan.13174] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/18/2022]
Abstract
AIM To synthesize qualitative descriptions of the experience of chronic pain across conditions. BACKGROUND Chronic pain is a transdiagnostic symptom in that while somatic pathology plays a role in activating pain pathways, psychological and social factors contribute to the experience of pain over time. The treatment of the underlying condition may require both biomedical intervention and biopsychosocial approaches. DESIGN Qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research (CERQual) developed by Grading of Recommendations Assessment Development and Evaluation (GRADE) working group to evaluate the strength of the evidence. DATA SOURCES PubMed and Ovid Medline from 2000-2015. REVIEW METHODS Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. RESULTS Forty-one papers exploring the experience of chronic pain were included in the review. Five meta-themes were identified across the studies: 1) the body as obstacle; 2) invisible but real; 3) disrupted sense of self; 4) unpredictability; and 5) keeping going. There was high confidence in the evidence for three themes: 'the body as obstacle'; 'disrupted sense of self' and 'keeping going'; and moderate confidence in the evidence for 'invisible but real' and 'unpredictability'. CONCLUSIONS The findings in this review suggest there are similarities in the experience of chronic pain across a range of conditions that have implications for the development of transdiagnostic pain management strategies and interventions.
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Affiliation(s)
- Marie Crowe
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Philippa Seaton
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Catherine Mccall
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Virginia Maskill
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Henrietta Trip
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
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Sherwood G, McNeill JA, Hernandez L, Penarrieta I, Petersen JM. A multinational study of pain management among Hispanics. J Res Nurs 2016. [DOI: 10.1177/174498710501000404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A multinational project involving pain research teams from three countries examined pain management outcomes in Hispanics. The limited research on pain management outcomes in Hispanics are primarily from the USA, lacking the distinct multinational cultural influences. This article compares the descriptive analysis of the post-operative pain experience of Hispanics in the USA, Puerto Rico and Mexico and tests the reliability of a new Spanish language instrument, the Cuestionario de Houston Sobre el Dolor (Houston Pain Outcome Instrument, HPOI). There were similarities in expectations related to pain relief, proportion of patients reporting worst pain, usual pain and pain-related interference with function. Significant differences were found on adequacy of pain management. Participants reported high use of non-pharmacologic approaches, particularly prayer and family support. The newly developed instrument indicated acceptable reliability in all settings, Chronbach’s Alpha > 0.75, with some variability by study site. Further cross-ethnic and multinational research are needed to provide culturally relevant evidence-based practice models to overcome barriers and reduce disparity.
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Affiliation(s)
| | | | | | - Isabel Penarrieta
- Universdad Autonoma de Tamaulipas, Faculty of Nursing Tampico, Mexico
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Sherwood GD, McNeill JA, Palos G, Starck P. Perspectives on pain: A qualitative analysis of the Hispanic pain experience. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960300800505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As a primarily subjective phenomenon, pain expression may vary among different populations. Patients from minority populations may be more likely to have poor pain management, less analgesia prescribed, and lower doses administered for their pain. To understand better the Hispanic pain experience, qualitative methods were used to gather data from postoperative adult Hispanic patients in both an urban and rural setting regarding their perspective and response to the pain experience. Descriptive qualitative analysis of interview data from a sample (n=35) of predominantly female, married and Catholic respondents, ranging in age from 23-80 years yielded five categories: Characteristics of the pain experience; Managing pain; Information about pain; Interactions with providers, and Cultural considerations. Several themes defined each category and were used in a larger study to develop a Spanish language instrument to measure pain outcomes. Descriptions of the categories and themes and implications for further research and clinical care are presented. For Hispanic populations, cultural issues having an impact on research regarding pain, such as simpatia (a striving for harmonious relationships without interpersonal conflict), respect, and family involvement, as well as problems with recruitment of minority patients to research studies, must be addressed to improve the effectiveness of pain management for this group.
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Affiliation(s)
- Gwen D. Sherwood
- The University of Texas, Health Science Center, Houston School of Nursing
| | | | - Guadalupe Palos
- Faculty, Pain Research Group, University of Texas, MD Anderson Cancer Center Houston, Texas
| | - Patricia Starck
- The University of Texas, Health Science Center, Houston School of Nursing
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McDonald DD, Thomas GJ, Livingston KE, Severson JS. Assisting Older Adults to Communicate Their Postoperative Pain. Clin Nurs Res 2016; 14:109-26; discussion 127-30. [PMID: 15793271 DOI: 10.1177/1054773804271934] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An intervention assisting older adults to communicate their pain was tested in a posttest-only experiment. Thirty-eight preoperative older adults were randomly assigned to a communication group watching a videotape about communicating and managing postoperative pain or a comparison group watching a videotape about managing postoperative pain only. Pain was measured on Postoperative Days 1 and 2, and 1 and 7 days after hospital discharge by a data collector blind to the condition. The communication group reported greater pain relief and less pain interference on Postoperative Day 1. The comparison group reported greater pain relief on Postoperative Day 2 after attaining a pain interference level similar to the pain communication group. The pain communication intervention had modest effects for reducing pain interference with activities on Postoperative Day 1. Greater pain relief might be achieved when older adults and their health care providers are more knowledgeable about both pain communication and pain management.
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22
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Ameringer S, Serlin RC, Hughes SH, Frierdich SA, Ward S. Concerns About Pain Management Among Adolescents With Cancer: Developing the Adolescent Barriers Questionnaire. J Pediatr Oncol Nurs 2016; 23:220-32. [PMID: 16766687 DOI: 10.1177/1043454206289736] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Investigators have examined barriers to pain management in adults with cancer, but these patient-related barriers have rarely been studied in adolescents. This article summarizes 2 studies used in the development and initial psychometric testing of the Adolescent Barriers Questionnaire (ABQ). Building on the Barriers Questionnaire-II, the ABQ is designed to measure the extent to which adolescents with cancer have concerns about reporting pain and using analgesics. Study 1 was a qualitative study investigating pain management concerns of 5 adolescents with cancer. Concerns emerged that could potentially impede pain management such as fear of addiction and worry about communicating pain to parents and providers. Each of the adolescents revealed at least 1 concern about pain management or held fatalistic beliefs that cancer pain cannot be relieved. In study 2, content validity of the preliminary ABQ (52 items assessing 13 barrier sub-scales) was assessed by 2 panels, adolescents with cancer and clinicians. Based on results, the ABQ was modified to contain 45 items that assess 11 barriers. Further examination of barriers in adolescents with cancer is warranted.
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Affiliation(s)
- Suzanne Ameringer
- School of Nursing, University of Wisconsin-Madison, Madison, WI 53792, USA.
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Kee CC, Foley BJ, Dudley WN, Jennings BM, Minick P, Harvey SS. Nursing Structure, Processes, and Patient Outcomes in Army Medical Centers. West J Nurs Res 2016; 27:1040-58. [PMID: 16275697 DOI: 10.1177/0193945905278587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to describe patient outcomes in Army Medical Centers, identify differences in outcomes between mixed medical-surgical bed and specialty intensive care units (ICUs), and explore predictive models for outcomes attributable to nursing structure and processes. Data were collected from 138 patients and 103 nurses in four medical-surgical and four ICUs in two Army Medical Centers. Significant differences for unit type were found for length of stay and patient satisfaction with nursing care. Outcome predictive models were modest (adjusted R2 = .16 to .24) and significant for length of stay, satisfaction with nursing care, satisfaction with pain management, and health status following discharge. Exploring differences and commonalities between military and civilian hospitals will ultimately provide insight into ways of improving patient outcomes and bettering the work environment of nurses.
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Affiliation(s)
- Carolyn C Kee
- Byrdine F. Lewis School of Nursing, Georgia State University, USA
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24
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Kim JH, Lhim SC, Roh SW, Lee SJ, Ko YM, Kim YO, Shin YS. Effects of Sequential Application of Superficial Cold and Heat on Pain, Patient Satisfaction with Pain Control, Comfort Level and Subjective Response after Spine Surgery. ACTA ACUST UNITED AC 2016. [DOI: 10.7739/jkafn.2016.23.2.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Connolly KL, Nehal KS, Dusza SW, Rossi AM, Lee EH. Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care. J Am Acad Dermatol 2016; 75:590-594. [PMID: 27125530 DOI: 10.1016/j.jaad.2016.02.1230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/18/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS. OBJECTIVE We sought to determine if patients experience pain during their MMS visit. METHODS In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0-10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day. RESULTS Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1-8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose. LIMITATIONS Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesthesia volume and oral pain medications. CONCLUSION Some patients experience pain during MMS. However, the majority of patients report a low level of pain. Additional preventative measures could be considered in patients at higher risk.
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Affiliation(s)
- Karen L Connolly
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Erica H Lee
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
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Beck S, Brant J, Donohue R, Smith E, Towsley G, Berry P, Guo JW, Al-Qaaydeh S, Pett M, Donaldson G. Oncology Nursing Certification: Relation to Nurses’ Knowledge and Attitudes About Pain, Patient-Reported Pain Care Quality, and Pain Outcomes. Oncol Nurs Forum 2016; 43:67-76. [DOI: 10.1188/16.onf.67-76] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, Montes A, Pergolizzi J. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 2015; 31:2131-43. [PMID: 26359332 DOI: 10.1185/03007995.2015.1092122] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of healthcare may be unwilling or unable to finance. Nevertheless, change is under way and the political will exists for it to continue.
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Affiliation(s)
- Winfried Meissner
- a a Leiter der Sektion Schmerz, Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum der FSU Jena , Germany
| | - Flaminia Coluzzi
- b b Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Dominique Fletcher
- c c Service Anesthésie Réanimation, Hôpital Raymond Poincare , Garches , France
| | - Frank Huygen
- d d University Hospital , Rotterdam , The Netherlands
| | | | - Edmund Neugebauer
- f f Faculty of Health , School of Medicine, Witten/Herdecke University , Cologne , Germany
| | | | - Joseph Pergolizzi
- h h Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
- i i Naples Anesthesia and Pain Associates , Naples , FL , USA
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Shoqirat N. “Sleepless Nights and Sore Operation Site”: Patients' Experiences of Nursing Pain Management After Surgery in Jordan. Pain Manag Nurs 2014; 15:609-18. [DOI: 10.1016/j.pmn.2013.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/24/2022]
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Vatansever NA, Akansel N. Validation study of the strategic and clinical quality indicators in postoperative pain management questionnaire in Turkish surgery patients. Pain Manag Nurs 2014; 15:871-80. [PMID: 24981119 DOI: 10.1016/j.pmn.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
Determining patient satisfaction with postoperative pain management is an important intervention to improve strategies for effective pain control. The aim of this study was to validate an English version of the 14-item Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire in Turkish language. The study included 113 patients who underwent elective surgeries at a university hospital in Bursa, Turkey. The data were collected after translation procedures and final adjustments were done on the original instrument. For the total scale, Cronbach's coefficient α was 0.81 and the main score obtained from the scale was 45.8 ± 10.8. Included were three subscales: nursing interventions, pain management, and environments. Of the patients, 40.7% reported more pain than expected in the postoperative period and their satisfaction with pain relief was 7.4 ± 2.5. This instrument is a reliable and valid instrument in Turkish language and can be used to evaluate the effectiveness of postoperative pain management.
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Affiliation(s)
| | - Neriman Akansel
- Department of Surgical Nursing, Uludag University School of Health, Bursa, Turkey.
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Higgs S, Henry R, Glackin M. Acute pain services following surgery for colorectal cancer. ACTA ACUST UNITED AC 2014; 23:S4, S6, S8-11. [DOI: 10.12968/bjon.2014.23.sup2.s4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon Higgs
- for Inpatient Pain, South Eastern Health and Social Care Trust
- Oncology and Palliative Care; at the School of Nursing and Midwifery, Queen's University Belfast
| | - Richard Henry
- Oncology and Palliative Care; at the School of Nursing and Midwifery, Queen's University Belfast
| | - Marie Glackin
- Oncology and Palliative Care; at the School of Nursing and Midwifery, Queen's University Belfast
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Abstract
The aim of this study was to examine the basic social psychological process of managing inadequately relieved pain in adults. Transcribed data from 23 ambulatory medical visits of adults with pain and interviews with four practitioners and four patients with pain were analyzed using constant comparative analysis. The basic problem was perception of running out of treatment options. Trialing was the process used to resolve the problem and consisted of four phases: finding the right practitioner, initiating the trial, adjusting treatments, and continuing to monitor with the patient taking control over the pain. Failure to achieve control over pain occurred when providers were unclear or failed to listen or when patients disagreed about treatment. Improving patient-provider communication may enhance trialing.
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Howarth M, Warne T, Haigh C. Pain from the inside: understanding the theoretical underpinning of person-centered care delivered by pain teams. Pain Manag Nurs 2013; 15:340-8. [PMID: 23433699 DOI: 10.1016/j.pmn.2012.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/06/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
Chronic back pain is globally acknowledged as a common reason why people seek help from health professionals. The complexity of persistent chronic pain can undermine the person's self-esteem and present a number of challenges to an individual's ability to manage their pain. Multi-professional person-centered care is advocated as a key strategy to support people with chronic back pain. However, the impact of these approaches on restoring the person's independence is unclear, and little is known about whether and how person-centered approaches restore autonomy and influence the person's ability to manage their pain. The aim of this grounded theory study was to generate understanding about person-centered care from the perspectives of people with chronic back pain and the multi-professional teams who cared for them. Semi-structured interviews were used to collect data from 17 people with chronic back pain over one year. A constant comparative analytical approach identified five key categories: the skeptical professional, validation, becoming a person, regaining control, and restoring faith. These categories formed the "conditional partnership" as a theory to explain person-centered care, which related to the way in which the partnership developed between the patients and teams. The findings suggest that person-centered care was influenced by the participants' need to be believed and the relationship developed with health care providers. Crucially, these findings suggest that legitimizing the pain experience through person-centered approaches to care can empower people with chronic back pain to regain control of their lives and their pain.
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Affiliation(s)
- Michelle Howarth
- School of Nursing, Midwifery and Social Work, University of Salford, Manchester, United Kingdom.
| | - Tony Warne
- School of Nursing, Midwifery and Social Work, University of Salford, Manchester, United Kingdom
| | - Carol Haigh
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
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Dalal S, Hui D, Nguyen L, Chacko R, Scott C, Roberts L, Bruera E. Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center. Cancer 2012; 118:3869-77. [PMID: 22180337 PMCID: PMC3310943 DOI: 10.1002/cncr.26694] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/28/2011] [Accepted: 10/12/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cancer pain initiatives recommend using the personalized pain goal to tailor pain management. This study was conducted to examine the feasibility and stability of personalized pain goal, and how it compares to the clinical pain response criteria. METHODS Records of 465 consecutive cancer patients seen in consultation at the Supportive Care Clinic were reviewed. Pain relief was assessed as clinical response (≥30% or ≥2 point pain reduction) and personalized pain goal response (pain ≤ personalized pain goal). RESULTS One hundred fifty-two (34%), 95 (21%), and 163 (37%) patients presented with mild (1-4), moderate (5-6), and severe (7-10) pain, respectively. Median age (59 years), males (52%), and advanced cancer status (84%) did not differ by pain category. Median personalized pain goal at initial clinic consult was 3 (interquartile range, 2-3), was similar across pain groups, and remained unchanged (P = .57) at follow-up (median, 14 days). Clinical response was higher among patients with severe pain (60%) as compared with moderate (40%) and mild pain (33%, P < .001). Personalized pain goal response was higher among patients with mild pain (63%) as compared with moderate (44%) and severe pain (27%, P < .001). By using personalized pain goal response as the gold standard for pain relief, the sensitivity of clinical response was highest (98%) among patients with severe pain, but it had low specificity (54%). In patients with mild pain, clinical response was most specific for pain relief (98%), but had low sensitivity (52%). CONCLUSIONS Personalized pain goal is a simple patient-reported outcome for pain goals. The majority of patients were capable of stating their desired level for pain relief. The median personalized pain goal was 3, and it was highly stable at follow-up assessment.
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Affiliation(s)
- Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Evaluating the effectiveness of pediatric pain management guidelines. J Pediatr Nurs 2012; 27:336-45. [PMID: 22703680 DOI: 10.1016/j.pedn.2011.06.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 05/31/2011] [Accepted: 06/05/2011] [Indexed: 11/21/2022]
Abstract
In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre-post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation.
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Kafkia T, Chamney M, Drinkwater A, Pegoraro M, Sedgewick J. Pain in chronic kidney disease: prevalence, cause and management. J Ren Care 2011; 37:114-22. [PMID: 21561548 DOI: 10.1111/j.1755-6686.2011.00234.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pain is an unpleasant sensory and emotional experience and is the most common symptom experienced by renal patients. It can be caused by primary co-morbid diseases, renal replacement therapies, medication or treatment side effects, and its intensity varies from moderate to severe. Pain management in renal patients is difficult, since the distance between pain relief and toxicity is very small. This paper will provide an algorithm for pain management proposed using paracetamol, nonsteroid anti-inflamatory drugs (NSAIDs), mild and stronger opioids as well as complementary techniques. Quality of Life (QoL) and overall enhancement of the patient experience through better pain management are also discussed. To improve pain management it is essential that nurses recognise that they have direct responsibilities related to pain assessment and tailoring of opioid analgesics and better and more detailed education.
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Chou PL, Lin CC. A pain education programme to improve patient satisfaction with cancer pain management: a randomised control trial. J Clin Nurs 2011; 20:1858-69. [DOI: 10.1111/j.1365-2702.2011.03740.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shaw S, Lee A. Student Nurses' Misconceptions of Adults with Chronic Nonmalignant Pain. Pain Manag Nurs 2010; 11:2-14. [DOI: 10.1016/j.pmn.2008.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/22/2008] [Indexed: 11/17/2022]
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Rejeh N, Vaismoradi M. Perspectives and experiences of elective surgery patients regarding pain management. Nurs Health Sci 2010; 12:67-73. [DOI: 10.1111/j.1442-2018.2009.00488.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beck SL, Towsley GL, Berry PH, Lindau K, Field RB, Jensen S. Core aspects of satisfaction with pain management: cancer patients' perspectives. J Pain Symptom Manage 2010; 39:100-15. [PMID: 19879107 DOI: 10.1016/j.jpainsymman.2009.06.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 06/01/2009] [Accepted: 06/17/2009] [Indexed: 11/18/2022]
Abstract
CONTEXT The coexistence of high levels of satisfaction and high levels of pain has been perplexing. OBJECTIVES The aims of this study were to 1) describe patient expectations related to the experience of cancer-related pain, 2) explore the cognitive processes and meaning that underlie patient judgments about satisfaction and dissatisfaction with pain management, and 3) explore the discrepancies between ratings of high satisfaction with pain management with high pain intensity. METHODS The sample included 33 patients: 18 with advanced cancer and 15 experiencing pain after a surgery for a cancer diagnosis. All patients had experienced "worst pain" of at least moderate intensity and were interviewed using standard pain measures from the American Pain Society Patient Outcome Questionnaire and open-ended questions about the underlying meaning of their answers. We systematically analyzed the transcribed qualitative data using NVivo software. RESULTS Fifty-five percent of patients were females and were aged 25-78 years. Most (75%) were satisfied or very satisfied with their overall pain management. Key findings indicate that for some, the worst pain rating was often brief, even momentary. Most patients expected pain relief. Four key themes were important to the quality of pain management: being treated right, having a safety net, being in a partnership with their health care team, and having pain treatment that was efficacious. Key aspects of the patient-provider relationship that mattered were how the nurses and doctors behaved toward them and how quickly they responded to reports of pain. For some, an important factor was whether they had control of the amount of pain they experienced. CONCLUSION The findings inform measurement of patient satisfaction with the quality of pain management.
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Affiliation(s)
- Susan L Beck
- University of Utah College of Nursing, Salt Lake City, Utah 84112-5880, USA.
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Heiwe S, Bjuke M. “An Evil Heritage”: Interview Study of Pain and Autosomal Dominant Polycystic Kidney Disease. Pain Manag Nurs 2009; 10:134-41. [DOI: 10.1016/j.pmn.2009.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 02/18/2009] [Accepted: 03/05/2009] [Indexed: 11/28/2022]
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DuPree E, Martin L, Anderson R, Kathuria N, Reich D, Porter C, Chassin MR. Improving Patient Satisfaction with Pain Management Using Six Sigma Tools. Jt Comm J Qual Patient Saf 2009; 35:343-50. [DOI: 10.1016/s1553-7250(09)35048-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McDonald DD, Shea M, Rose L, Fedo J. The effect of pain question phrasing on older adult pain information. J Pain Symptom Manage 2009; 37:1050-60. [PMID: 19500724 PMCID: PMC2694581 DOI: 10.1016/j.jpainsymman.2008.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 06/02/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022]
Abstract
The aim of this study was to test how practitioners' pain communication affected the pain information provided by older adults. A post-test only, double-blind experiment was used to test how the phrasing of practitioners' pain questions-open-ended and without social desirability bias; closed-ended and without social desirability bias; or open-ended and with social desirability bias-affected the pain information provided by 312 community-living older adults with osteoarthritis pain. Older adults were randomly assigned to one of the three pain phrasing conditions to watch and orally respond to a computer-displayed videotape of a practitioner asking about their pain. All responded to a second videotape of the practitioner asking if there was anything further they wanted to communicate. Lastly, all responded to a third videotape asking if there was anything further they wanted to communicate about their pain. Transcripts of the audiotaped responses were content analyzed using 16 a priori criteria from national guidelines to identify important pain information for osteoarthritis pain management. Older adults described significantly more pain information in response to the open-ended question without social desirability. The two follow-up questions elicited significant additional information for all three groups, but did not compensate for the initial reduced pain information from the closed-ended and social desirability-biased groups. Initial use of an open-ended pain question without social desirability bias and use of follow-up questions significantly increase the amount of important pain information provided by older adults with osteoarthritis pain.
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Affiliation(s)
- Deborah Dillon McDonald
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026, USA.
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McDonald DD, Shea M, Fedo J, Rose L, Bacon K, Noble K, Stewart J. Older Adult Pain Communication and the Brief Pain Inventory Short Form. Pain Manag Nurs 2008; 9:154-9, 159.e1-2. [DOI: 10.1016/j.pmn.2008.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 02/29/2008] [Accepted: 03/03/2008] [Indexed: 10/21/2022]
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Abstract
Cancer pain is estimated to occur in 30% to 70% of patients with early-stage cancer and 60% to 95% with advanced cancer. Current research shows that cancer pain continues to be undertreated despite the availability of analgesics and established guidelines to maximize their effectiveness. The purpose of this study was to describe oncology patients' pain experience during an episode of hospitalization with particular emphasis on exploring the relationship between oncology patients' beliefs about pain and the treatment they received. Consecutive patients (n = 126) were interviewed 48 hours after admission to an urban and a regional hospital in Australia; 47.6% of patients had experienced moderate to severe pain in the previous 24 hours but had only received 40.4% of available analgesic. Patients held varying beliefs about pain and pain treatments in particular, 41% held strong beliefs about the potential for addiction to narcotics. Patients who held this belief reported higher current pain, worst pain intensity, and higher average pain intensity in the previous 24 hours. Effective pain management in the inpatient oncology setting continues to be an important clinical issue, and patients do not receive all available pain treatment. There may be an important association between patients' beliefs about pain and pain management and the pain management they receive.
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Idvall E, Bergqvist A, Silverhjelm J, Unosson M. Perspectives of Swedish patients on postoperative pain management. Nurs Health Sci 2008; 10:131-6. [DOI: 10.1111/j.1442-2018.2008.00380.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ward S, Donovan H, Gunnarsdottir S, Serlin RC, Shapiro GR, Hughes S. A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). Health Psychol 2008; 27:59-67. [PMID: 18230015 DOI: 10.1037/0278-6133.27.1.59] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Based on theories regarding cognitive representations of illness and processes of conceptual change, a representational intervention to decrease cancer pain (RIDcancerPain) was developed and its efficacy tested. DESIGN A two-group RCT (RIDcancerPain versus control) with outcome and mediating variables assessed at baseline (T1) and 1 and 2 months later (T2 and T3). Subjects were 176 adults with pain related to metastatic cancer. MAIN OUTCOME MEASURES Outcome variables were two pain severity measures (BPI and TPQM), pain interference with life, and overall quality of life. Mediating variables were attitudinal barriers to pain management and coping (medication use). RESULTS One hundred and fifty subjects completed the study. Subjects in RIDcancerPain (T1-T2 and T1-T3) showed greater decreases in Barrier scores than those in control. Subjects in RIDcancerPain (T1-T3) showed greater decreases in pain severity than those in control. Change in Barriers scores mediated the effect of RIDcancerPain on pain severity. CONCLUSION RIDcancerPain was efficacious with respect to some outcomes. Further work is needed to strengthen it.
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Affiliation(s)
- Sandra Ward
- School of Nursing, University of Wisconsin-Madison
| | | | | | - Ronald C Serlin
- Department of Educational Psychology, University of Wisconsin-Madison
| | | | - Susan Hughes
- School of Nursing, University of Wisconsin-Madison
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