1
|
Dash S, Singh PA, Bajwa N, Choudhury A, Bisht P, Sharma R. Why Pharmacovigilance of Non-steroidal Anti-inflammatory Drugs is Important in India? Endocr Metab Immune Disord Drug Targets 2024; 24:731-748. [PMID: 37855282 DOI: 10.2174/0118715303247469230926092404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/15/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are among the drugs that are most regularly administered to manage inflammation and pain. Over-the-Counter (OTC) NSAIDs are widely accessible, particularly in developing countries like India. This casual approach to using NSAIDs may operate as a magnet for NSAID-related adverse drug reactions (ADRs) among patients. OBJECTIVES As patients in India are less informed about the appropriate use of NSAIDs and consumption patttern, adverse drug reactions, and the importance of reporting ADRs, the current study's objective is to promote patient safety by using pharmacovigilance as a tool to educate patients. METHODS A targeted literature methodology was utilized to gather the data pertaining to NSAIDs, their ADRs and their pharmacovigilance. Different scientific databases, such as Science Direct, PubMed, Wiley Online Library, Springer, and Google Scholar, along with authentic textbooks, were explored as reference literature. RESULTS In general, NSAIDs consumption pattern depends upon the different age groups. Around 1.6 billion tablets of NSAIDs are consumed in India for ailments, such as headaches, arthritis, menstrual cramps, osteoarthritis, back pain, rheumatoid arthritis, gout, osteoporosis, tendinitis, cancer pain and chronic pain. Common ADRs of NSAIDs include nausea, vomiting, headache, gastritis, abdominal pain, and diarrhoea. Also, they can cause renal damage and cardiovascular problems if not consumed in a dose-dependent manner. However, Diclofenac and Ibuprofen have both been linked to depression and dementia. There have been reports of aplastic anaemia, agranulocytosis linked to phenylbutazone, Stevens-Johnson, and Lyell's syndrome linked to isoxicam and piroxicam, as well as the vulnerability of new-borns to Reye's syndrome after aspirin use. Lack of awareness, time constraints and unpredictability, poor training in ADRs identification, etc., are some of the reasons for the under-reporting of ADR of NSAIDs in India. CONCLUSION In order to rationally prescribe NSAIDs, it is essential to be aware of probable ADR's and establish prescription guidelines. Prescribers' behaviour can be changed toward excellent prescribing practices by conducting routine prescription assessments dealing with NSAIDs and providing feedback. In the near future, it will be critical to strengthen ADR data management and expand the reach of pharmacovigilance programs, ADR monitoring centers, and healthcare professionals' especially pharmacists' training in rural locations.
Collapse
Affiliation(s)
- Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Rajiv Sharma
- College of Pharmacy, Desh Bhagat University, Mandi Gobindgarh, Punjab, India
| |
Collapse
|
2
|
Althagafi SM, Hughes JA. Identifying the relationship between patient-reported outcomes and treatment with opiates in the adult emergency department - A cross-sectional study. Int Emerg Nurs 2022; 62:101152. [PMID: 35245729 DOI: 10.1016/j.ienj.2022.101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/09/2022] [Accepted: 01/31/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Suhair M Althagafi
- School of Nursing, Queensland University of Technology, Brisbane, Australia; College of Nursing, Umm AlQura University, Makkah, Saudi Arabia
| | - James A Hughes
- School of Nursing, Queensland University of Technology, Brisbane, Australia.
| |
Collapse
|
3
|
Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals. Healthcare (Basel) 2021; 9:healthcare9020171. [PMID: 33562852 PMCID: PMC7914438 DOI: 10.3390/healthcare9020171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
Abstract
Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient’s quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.
Collapse
|
4
|
Valeberg BT, Dihle A, Småstuen MC, Endresen AO, Rustøen T. The effects of a psycho-educational intervention to improve pain management after day surgery: A randomised clinical trial. J Clin Nurs 2021; 30:1132-1143. [PMID: 33432643 DOI: 10.1111/jocn.15659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 11/17/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of a psycho-educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function. BACKGROUND Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed. DESIGN Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used. METHODS Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi-squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures. RESULTS After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence. CONCLUSIONS No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed. RELEVANCE TO CLINICAL PRACTICE Day surgery patients' postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01595035).
Collapse
Affiliation(s)
- Berit T Valeberg
- Oslo Metropolitan University, Oslo, Norway.,University of South-East, Borre, Norway
| | | | - Milada C Småstuen
- Oslo Metropolitan University, Oslo, Norway.,University in Oslo, Oslo, Norway
| | | | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
5
|
Assessment of Patient's Satisfaction and Associated Factors regarding Postoperative Pain Management at the University of Gondar Compressive Specialized Hospital, Northwest Ethiopia. Pain Res Manag 2020; 2020:8834807. [PMID: 33273994 PMCID: PMC7676941 DOI: 10.1155/2020/8834807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
Objective We aimed to assess the level of patient's satisfaction and associated factors regarding postoperative pain management. Methods An institution-based cross-sectional study was conducted from April to May 2018 at the University of Gondar, and comprehensive specialized hospital data were collected through semistructured questionnaire and chart review. Level of satisfaction was measured using five-point Likert scale. Statistical analysis was done using SPSS software version 23. Both bivariable and multivariable logistic regression analyses were done. Variables of P value ≤0.2 in the bivariable analysis were a candidate for multivariable logistic regression. A P value ≤0.05 was considered as significantly associated with patient's level of satisfaction at 95% CI. Results A total of 418 patients were included in this study with a response rate of 98.58%. The overall proportion of patients who were satisfied with pain management services was 72.2% (95% CI: 67.7-76.6). ASA1 (AOR = 3.55: 95% CI = 1.20-10.55) and ASA2 patients (AOR = 3.72: 95% CI = 1.04-13.28), absence of postoperative pain (AOR = 1.86: 95% CI = 1.02-3.39), peripheral nerve block done (AOR = 9.14: 95% CI = 3.93 20.86), received analgesic before request (AOR = 6.90: 95% CI = 3.72-12.83), and received systemic analgesics (AOR = 6.10: 95% CI = 1.17-33.91) were significantly associated with the level of satisfaction. Conclusion The level of patient satisfaction with postoperative pain management was considerably low. Hence, it is vital to implement time-interval pain assessment method during the first 24 hours of postoperative period and treat accordingly based on the WHO pain ladder. Moreover, we suggested that all patients who underwent major surgery should receive peripheral nerve block as part of multimodal analgesia to decrease the incidence and severity of post op pain.
Collapse
|
6
|
Yu R, Zhuo Y, Feng E, Wang W, Lin W, Lin F, Li Z, Lin L, Xiao L, Wang H, Huang Y, Wu C, Zhang Y. The effect of musical interventions in improving short-term pain outcomes following total knee replacement: a meta-analysis and systematic review. J Orthop Surg Res 2020; 15:465. [PMID: 33036637 PMCID: PMC7547446 DOI: 10.1186/s13018-020-01995-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing number of patients continue to receive total knee replacement (TKR) surgery. Nevertheless, such surgeries result in moderate to severe postoperative pain and difficulty in managing it. Musical interventions are regarded as a type of multimodal analgesia, achieving beneficial results in other clinical treatments. This study aims to evaluate the effect of musical interventions in improving short-term pain outcomes following TKR in order to determine a more reasonable and standard way of delivering musical intervention. METHODS A systematic search was conducted to identify available and relevant randomized controlled trials (RCTs) regarding musical interventions compared against non-musical interventions in patients treated with TKR in Embase, MEDLINE, Cochrane Library, Web of Science, CNKI, and Wanfang Med Online up to 8 January 2020. The authors independently assessed study eligibility and risk of bias and collected the outcomes of interest to analyze. The statistical analysis was conducted using the Review Manager (RevMan) version 5.30 software. RESULTS Eight RCTs comprised of 555 patients satisfied the inclusion criteria and were enrolled in the present study. The results showed no significant difference between the music and control groups in pain of the visual analog scale (VAS), during postoperative recovery room, back to the ward after surgery; anxiety degree of VAS; heart rate; respiratory rate; oxygen saturation; blood pressure, systolic blood pressure, and diastolic blood pressure. Nevertheless, significant differences were observed between the two groups in average increase in continuous passive motion (CPM) angles and LF/HF ratio (one kind index of heart rate variability). CONCLUSIONS Musical interventions fail to demonstrate an obvious effect in improving short-term pain outcomes following TKR. A reasonable standardization of musical interventions, including musical type, outcome measures used, outcomes measured, duration, timing and headphones or players, may improve pain outcomes with certain advantages and should be further explored after TKR.
Collapse
Affiliation(s)
- Rongguo Yu
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Youguang Zhuo
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Eryou Feng
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Wulian Wang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Wentao Lin
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Feitai Lin
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Zhanglai Li
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Liqiong Lin
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Lili Xiao
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Haiyang Wang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Yuting Huang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Chunlin Wu
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Yiyuan Zhang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China.
| |
Collapse
|
7
|
Khaw D, Bucknall T, Considine J, Duke M, Hutchinson A, Redley B, de Steiger R, Botti M. Six-year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single-site observational study of pain management. Eur J Pain 2020; 25:107-121. [PMID: 32969139 DOI: 10.1002/ejp.1652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Guidelines for acute postoperative pain management recommend administering analgesics in multimodal combination to facilitate synergistic benefit, reduce opioid requirements and decrease side-effects. However, limited observational research has examined the extent to which multimodal analgesics are prescribed and administered postoperatively following joint replacement. METHODS In this longitudinal study, we used three-point prevalence surveys to observe the 6-year trends in prescribing and use of multimodal analgesics on the orthopaedic wards of a single Australian private hospital. We collected baseline postoperative data from total hip and knee arthroplasty patients in May/June 2010 (Time 1, n = 86), and follow-up data at 1 year (Time 2, n = 199) and 5 years (Time 3, n = 188). During the follow-up, data on prescribing practices were presented to anaesthetists. RESULTS We found a statistically significant increase in the prescribing (p < 0.001) and use (p < 0.001) of multimodal analgesics over time. The use of multimodal analgesics was associated with lower rest pain (p = 0.027) and clinically significant reduction in interference with activities (p < 0.001) and sleep (p < 0.001). However, dynamic pain was high and rescue opioids were likely under-administered at all time points. Furthermore, while patients reported high levels of side-effects, use of adjuvant medications was low. CONCLUSIONS We observed significant practice change in inpatient analgesic prescribing in favour of multimodal analgesia, in keeping with contemporary recommendations. Surveys, however, appeared to identify a clinical gap in the bedside assessment and management of breakthrough pain and medication side-effects, requiring additional targeted interventions. SIGNIFICANCE Evaluation of 6-year trends in a large Australian metropolitan private hospital indicated substantial growth in postoperative multimodal analgesic prescribing. In the context of growing global awareness concerning multimodal analgesia, findings suggested diffusion of best-evidence prescribing into clinical practice. Findings indicated the effects of postoperative multimodal analgesia in real-world conditions outside of experimental trials. Postoperative multimodal analgesia in the clinical setting was only associated with a modest reduction in rest pain, but substantially reduced interference from pain on activities and sleep.
Collapse
Affiliation(s)
- Damien Khaw
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Melbourne, VIC, Australia
| | - Tracey Bucknall
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research Alfred Health Partnership, Melbourne, VIC, Australia
| | - Julie Considine
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research-Eastern Health Partnership, Melbourne, VIC, Australia
| | - Maxine Duke
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | - Ana Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Melbourne, VIC, Australia
| | - Bernice Redley
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research-Monash Health Partnership, Melbourne, VIC, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, VIC, Australia
| | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Melbourne, VIC, Australia
| |
Collapse
|
8
|
Krupic F, Grbic K, Senorski EH, Lepara O, Fatahi N, Svantesson E. Experience of Intensive Care Nurses in Assessment of Postoperative Pain in Patients with Hip Fracture and Dementia. Mater Sociomed 2020; 32:50-56. [PMID: 32410892 PMCID: PMC7219725 DOI: 10.5455/msm.2020.32.50-56] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Patients with hip fracture are one of the most demanding groups in the health-care system. One of the most important tasks for nurses is to assess pain and ensure the patients are pain free. Pain assessment in patients with dementia is a well-known challenge for health-care professionals due to the patients’ difficulties in verbalising pain problems. Aim: The aim of this study was to explore the experience of intensive care nurses in assessment of pain in patients with hip fracture and dementia in the postoperative setting. Methods: Data were collected through five focus group discussions using open-ended questions and qualitative content analysis. Twenty-one intensive care nurses (6 men and 15 women) participated in the focus group interviews. Results: Analysis of the data resulted in three main categories: “Communication”, “Visual assessment of pain”, and “Practical issues” including a number of subcategories. Some of the factors which influence assessment of pain in patients with dementia are the lack of information and knowledge about the patients, which causes loss of time and increased stress. The different forms of communication and ways of assessing pain in these patients were other factors mentioned by nurses as hindrances regarding assessment of the pain. Conclusion: In order to improve assessment of pain, more knowledge and information about the patients are needed and better coordination between the pre- and postoperative departments regarding these patients. In this context, different intervention studies on patient’s hip fracture and dementia are needed to increase knowledge and awareness regarding this group of patients.
Collapse
Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesiology. Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kemal Grbic
- Clinical of Thoracic Surgery, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Eric Hamrin Senorski
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Orhan Lepara
- Department of Human Physiology, Shool of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nabi Fatahi
- Department of Learning and Ledarship for Health care Professionals, Sahlgrenska Akademin at University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Haileamlak A, Michael GG, Ayele Y, Irnich D. Quality of postoperative pain management in Ethiopia: A prospective longitudinal study. PLoS One 2019; 14:e0215563. [PMID: 31042777 PMCID: PMC6494043 DOI: 10.1371/journal.pone.0215563] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. In Africa, there are scanty data available that make use of multi-center data to characterize the quality of postoperative pain management. In this study using a longitudinal data, we have attempted to characterize the quality of postoperative pain management; among patients scheduled for major elective orthopedic, gynecologic and general surgery. Methods This prospective longitudinal study evaluated the quality of postoperative pain management in patients undergoing elective general, gynecologic, and orthopedic surgery. We quantified the prevalence of moderate to severe postoperative pain with the International Pain Outcome Questionnaire and the corresponding adequacy of treatment with the pain management index. At four time points after surgery, we estimated pain severity, its physical and emotional interference, and patient satisfaction. Results Moderate to severe postoperative pain was present in 88.2% of patients, and pain was inadequately treated in 58.4% of these patients. Chronic pain (β = 0.346, 95% CI: 0.212, 0.480) predicted patients’ worst pain intensity. Gender was not associated with the worst pain intensity or percentage of time spent in severe pain. Patient’s pain intensity did not predicted the level of satisfaction. Conclusions The prevalence of moderate to severe postoperative pain and its functional interference is high in Ethiopian patients. The treatment provided to patients is inadequate and not in line with international recommendations and standards.
Collapse
Affiliation(s)
- Million Tesfaye Eshete
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Petra I. Baeumler
- Multidisciplinary Pain Center, Department of Anesthesiology, University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Matthias Siebeck
- CIHLMU Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany
- Department of General, Visceral und Transplantation Surgery, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Haileamlak
- Department of Pediatrics and Child Health, Institute Of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Girma G. Michael
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Yemane Ayele
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Dominik Irnich
- Multidisciplinary Pain Center, Department of Anesthesiology, University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| |
Collapse
|
10
|
Chaw S, Lo Y, Shariffuddin II, Wong J, Lee J, Leong DW, Ng KW, Chan L. Evaluation of the quality of acute pain management in a pediatric surgical setting: Validation of a parent proxy modified version of the revised American Pain Society Patient Outcome Questionnaire. Paediatr Anaesth 2019; 29:68-76. [PMID: 30381868 DOI: 10.1111/pan.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Effective pain management involves a cycle of continual pain assessment, good pain control strategies, and assessment of a standard quality improvement measures. A validated questionnaire that focuses on the quality of postoperative pain management in pediatric surgical patients and parental satisfaction on pain treatment is lacking. We, therefore, modified the revised American Pain Society Patient Outcome Questionnaire to evaluate the quality of postoperative pain management in a pediatric surgical setting. The primary aim of this study was to validate the modified version of revised American Pain Society Patient Outcome Questionnaire. METHODS Parents whose children aged below 12 years and were scheduled for elective surgery in a teaching hospital, were approached to participate in this survey. The reliability of the modified version of revised American Pain Society Patient Outcome Questionnaire was evaluated using Cronbach's alpha test, while the construct validity was assessed with a principal component analysis using a varimax rotation. The parental satisfaction with pain treatment received was measured. RESULTS A total of 108 parents completed the questionnaire. The internal consistency of the questionnaire shows a Cronbach's alpha of 0.798. Principal component analysis revealed a four-factor structure of the 12 items which explained 69.7% of the total variance. The factors are "Interference of sleep and activity," "Pain severity and drowsiness," "Perception of care," and "Adverse effects," respectively. Our study showed that this questionnaire is a valid and reliable measure for "Interference of sleep and activity" and "Pain severity and drowsiness" factors, but not for "Perception of care" and "Adverse effects." The results for "Perception of care" and "Adverse effects," therefore, should be reported as individual items instead of total score. The parental satisfaction with pain treatment given was good (median 8.0; IQR 3.0). CONCLUSION The modified version of revised American Pain Society Patient Outcome Questionnaire is a feasible and easy instrument to administer. The questionnaire can be used to obtain feedback from parents about the outcomes and experiences of pain management and is helpful in continuous quality evaluation and improvement in the postoperative care in a pediatric setting.
Collapse
Affiliation(s)
- SookHui Chaw
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - YokeLin Lo
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Ina I Shariffuddin
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - JiaWing Wong
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - JiaYin Lee
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - David WeiJie Leong
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kevin WeiShan Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lucy Chan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
11
|
Petti E, Scher C, Meador L, Van Cleave JH, Reid MC. Can Multidimensional Pain Assessment Tools Help Improve Pain Outcomes in the Perianesthesia Setting? J Perianesth Nurs 2018; 33:767-772. [PMID: 30236587 PMCID: PMC6166883 DOI: 10.1016/j.jopan.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/21/2018] [Indexed: 12/21/2022]
|
12
|
Langerud AK, Rustøen T, Brunborg C, Kongsgaard U, Stubhaug A. Prevalence, Location, and Characteristics of Chronic Pain in Intensive Care Survivors. Pain Manag Nurs 2018; 19:366-376. [PMID: 29455923 DOI: 10.1016/j.pmn.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND A growing number of studies have addressed the long-term consequences of intensive care unit (ICU) treatment, but few have studied the prevalence of chronic pain and pain characteristics longitudinally. AIMS The goal of the work described here was to investigate the prevalence and characteristics of chronic pain in ICU survivors 3 months and 1 year after ICU discharge and to identify risk factors for chronic pain 1 year after ICU discharge. DESIGN The design used was an explorative and longitudinal study. SETTING/PATIENTS The patients in this work had stayed >48 hours in two mixed ICUs in Oslo University Hospital, a tertiary referral hospital. METHODS Patients completed a survey questionnaire 3 months and 1 year after ICU discharge. Pain was assessed using the Brief Pain Inventory-Short Form. RESULTS At 3 months after discharge, 58 of 118 ICU survivors (49.2%) reported pain, and at 1 year after discharge, 34 of 89 survivors (38.2%) reported pain. The most common sites of pain at 3 months were the shoulder and abdomen; the shoulder remained the second most common site at 1 year. There was an increase in the interference of pain with daily life at 1 year. Possible risk factors for chronic pain at 1 year were increased severity of illness, organ failure, ventilator time >12 days, and ICU length of stay >15 days. The most common sites of pain were not linked to the admission diagnosis. CONCLUSIONS These findings may enable health care providers to improve care and rehabilitation for this patient group.
Collapse
Affiliation(s)
- Anne Kathrine Langerud
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, University of Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ulf Kongsgaard
- Faculty of Medicine, University of Oslo, Norway; Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|
13
|
Iohom G. To block or not to block? Rom J Anaesth Intensive Care 2017; 24:83-85. [PMID: 29090258 DOI: 10.21454/rjaic.7518.242.ioh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gabriella Iohom
- Consultant Anaesthetist/Senior Lecturer, Cork University Hospital/University College Cork, Cork, Ireland
| |
Collapse
|
14
|
Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry. THE JOURNAL OF PAIN 2017; 18:1237-1252. [DOI: 10.1016/j.jpain.2017.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/31/2017] [Indexed: 12/16/2022]
|
15
|
Fang H, Liang J, Hong Z, Sugiyama K, Nozaki T, Kobayashi S, Sameshima T, Namba H, Asakawa T. Psychometric evaluation of the Chinese version of the revised American Pain Society Patient Outcome Questionnaire concerning pain management in Chinese orthopedic patients. PLoS One 2017; 12:e0178268. [PMID: 28542551 PMCID: PMC5444797 DOI: 10.1371/journal.pone.0178268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/08/2017] [Indexed: 12/16/2022] Open
Abstract
The present study tested the clinical efficiency (item grouping, internal consistency of the subscales, construct validity, and clinical feasibility) of a widely used pain assessment system, the Mandarin version of the American Pain Society Patient Outcome Questionnaire (APS-POQ-R-C), in Chinese patients. We also attempted to investigate the current quality of pain management provided in orthopedic inpatient units in China and provide baseline data. First, we investigated the test–retest reliability of APS-POQ-R-C. In total, 236 orthopedic patients were evaluated. Our results showed that APS-POQ-R-C has satisfactory internal consistency and construct validity, although some items are not appropriate for orthopedic patients. Test–retest reliability outcomes indicated that APS-POQ-R-C is a satisfactory battery with acceptable validity and reliability, and is therefore recommended for pain management in future studies.
Collapse
Affiliation(s)
- Huan Fang
- Department of Pharmacy, Jinshan Hospital of Fudan University, Shanghai, China
- * E-mail: (TA); (HF)
| | - Jingjuan Liang
- Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- * E-mail: (TA); (HF)
| |
Collapse
|
16
|
Wang H, Sherwood GD, Gong Z, Ren L, Liu H. Reliability and Validity of the Chinese Version of the Revised American Pain Society Patient Outcome Questionnaire in Postoperative Patients. Pain Manag Nurs 2017; 18:110-120. [PMID: 28259638 DOI: 10.1016/j.pmn.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/30/2022]
Abstract
The American Pain Society Patient Outcome Questionnaire and the subsequent revised version are the most frequently reported measures of the quality of pain management. However, the reliability and validity of the revised questionnaire have not been reported in Chinese patients. This study sought to evaluate the psychometric properties of the Chinese version of the revised questionnaire in postoperative patients in China. The study was a descriptive, cross-sectional psychometric study. The revised questionnaire was translated into Chinese according to international guidelines and then administered to participants. The patients' present, average, and worst pain intensity were evaluated in face-to-face interviews. The Pain Management Index was calculated according to the worst pain intensity and the classification of analgesic drugs used by the patients. The continuous items in the revised questionnaire demonstrated excellent construct validity and acceptable internal consistency reliability (0.732). Cronbach's alpha coefficients for the following subscales were acceptable: pain severity and sleep interference (0.773), activity interference (0.812), affective (0.824), and adverse effects (0.636); the exception was for the perception of pain care subscale (0.492). Patients with different anticipated pain management outcomes were differentiated as expected. Satisfaction could be predicted (31.3% of the variance) using subscales and items in the questionnaire. Although our evidence supports the psychometric properties of the Chinese version of the revised questionnaire when tested with postoperative patients, further study is needed, especially on the subscale perception of pain care.
Collapse
Affiliation(s)
- Hui Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gwen D Sherwood
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zhiyi Gong
- Department of Anesthesia, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Liying Ren
- Operation Room, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Huaping Liu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| |
Collapse
|
17
|
Barrington JW, Emerson RH, Lovald ST, Lombardi AV, Berend KR. No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA. Clin Orthop Relat Res 2017; 475:94-105. [PMID: 27339124 PMCID: PMC5174037 DOI: 10.1007/s11999-016-4931-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. QUESTIONS/PURPOSES (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA? (2) Do patients treated with liposomal bupivacaine-based PAI experience fewer opioid-related adverse events compared with patients treated with morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA? METHODS This multicenter, blind trial randomized 119 patients undergoing TKA with spinal anesthesia to receive spinal anesthesia plus periarticular injection with liposomal bupivacaine (40 patients), spinal anesthesia with bupivacaine plus intrathecal morphine (41 patients) but no liposomal bupivacaine injection, or spinal anesthesia with bupivacaine (38 patients) and no liposomal bupivacaine injection. The two groups that did not receive periarticular liposomal bupivacaine did receive periarticular injection with ropivacaine, and all three groups had ketorolac (30 mg) plus epinephrine (1:1000) in the periarticular injections. Patients in all three groups received identical perioperative multimodal analgesic and antiemetic drugs. All patients were analyzed in the group to which they were randomized and no patients were lost to followup. The primary study endpoints were visual analog score (VAS) for pain and narcotic use during postoperative day 1. Secondary endpoints included side effects associated with narcotic administration during the hospital stay. RESULTS Mean VAS pain in the liposomal bupivacaine PAI group was lower than that for the ropivacaine PAI group at 6 hours (1.8 ± 2.1 versus 3.3 ± 2.3, p = 0.005, mean difference: 1.5, 95% confidence interval [CI], 0.5-2.5) and 12 hours (1.5 ± 2.0 versus 3.3 ± 2.4, p < 0.001, mean difference: 1.8, 95% CI, 0.8-2.8) after surgery. The morphine spinal group had lower pain compared with the liposomal bupivacaine PAI group at 6 hours (0.9 ± 1.8 versus 1.8 ± 2.1, p = 0.035, mean difference: 1.0, 95% CI, 0.1-1.8), but there was no difference at 12 hours (0.8 ± 1.5 versus 1.5 ± 2.0, p = 0.086, mean difference: 0.7, 95% CI, -0.1 to 1.5). The magnitude of the differences at 6 and 12 hours are near the lower end of minimal clinically important differences reported in the literature, and thus the improvement shown in this study may only represent a small clinical improvement. Both the liposomal bupivacaine group (13% [five of 40]) and the ropivacaine group (5% [two of 38]) had fewer incidents of itching (pruritus) than the spinal morphine group (38% [15 of 41]) (p = 0.001). CONCLUSIONS This prospective multicenter three-arm blind randomized controlled trial showed potentially improved pain control at 6 and 12 hours in the liposomal bupivacaine and intrathecal morphine groups compared with the ropivacaine group at the cost of much higher incidences of pruritus (itching) in the intrathecal morphine group. Based on these results, we prefer the use of PAI with liposomal bupivacaine as an alternative to spinal anesthesia with intrathecal morphine as a result of similar postoperative pain control and the potential for reducing adverse events. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- John W. Barrington
- grid.418661.cPlano Orthopedic Sports Medicine and Spine Center, Plano, TX USA
| | | | - Scott T. Lovald
- grid.418983.f0000000096620001Exponent, Inc, 149 Commonwealth Drive, Menlo Park, CA 19104 USA
| | | | | |
Collapse
|
18
|
Lindberg MF, Miaskowski C, Rustøen T, Rosseland LA, Paul SM, Lerdal A. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty. PLoS One 2016; 11:e0161681. [PMID: 27583551 PMCID: PMC5008744 DOI: 10.1371/journal.pone.0161681] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 08/10/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. METHODS Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. RESULTS Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. DISCUSSION Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.
Collapse
Affiliation(s)
- Maren Falch Lindberg
- Department of Surgery, Lovisenberg Diakonale Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Anners Lerdal
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway
- * E-mail:
| |
Collapse
|
19
|
Connor LO. Developing 'subject matter experts': an improvement methodology programme for acute postoperative pain with patients post major surgery. J Clin Nurs 2016; 25:2629-38. [PMID: 27334830 DOI: 10.1111/jocn.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine the effectiveness of an improvement methodology initiative, directed at refining the quality of acute pain management of patients in the first 24 hours post major surgery using the Revised American Pain Society Patient Outcome Questionnaire, pre- and post development of a 'subject matter experts' acute pain programme. BACKGROUND Accurately measuring effectiveness of acute pain management post major surgery is intertwined with measuring overall patient satisfaction. A critical element of quality evaluation is obtaining direct feedback from patients about the here-and-now pain experiences post major surgery. METHODS A prospective cross-sectional, observational study was conducted in a large university hospital in Ireland. The questionnaire was completed with patients within 24 hours post major surgery, i.e., cardiothoracic, breast, gynaecological, gastrointestinal and urology surgery. The nurse participants were selected based on their commitment to play a key role in acute pain management. The study consisted of: a pre programme phase (n = 100 patients), an intervention phase - 'subject matter experts' acute pain programme (n = 24 nurses) and a postprogramme phase (n = 100 patients). RESULTS Over a quarter of patients were in severe pain for long periods in the first 24 hours post major surgery. These findings were linked not only to ineffective analgesia from some pain drug therapies but also to contradictory messages from nurses. Over half of the patients' pre- and postintervention reported satisfaction with acute pain management, whereas the remainder were dissatisfied and some sought answers to their suboptimum pain status. The 'subject matter experts' had a noteworthy impact on the patients' pain beliefs. CONCLUSIONS The findings revealed that a 'subject matter experts' acute pain programme can have a positive impact on pain management in the immediate phase post major surgery. RELEVANCE TO CLINICAL PRACTICE The role making of 'subject matter experts' in acute pain is a tactical approach towards achieving optimum patient pain control in the immediate phase post major surgery.
Collapse
Affiliation(s)
- Laserina O Connor
- Mater Misericordiae University Hospital, St Vincent's Health Care Group, University College Dublin, Dublin, Ireland.
| |
Collapse
|
20
|
Eriksson K, Wikström L, Fridlund B, Årestedt K, Broström A. Patients' experiences and actions when describing pain after surgery--a critical incident technique analysis. Int J Nurs Stud 2015; 56:27-36. [PMID: 26772655 DOI: 10.1016/j.ijnurstu.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. OBJECTIVE The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. METHODS An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. FINDINGS Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals' large work load.
Collapse
Affiliation(s)
- Kerstin Eriksson
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, 551 85 Jönköping Sweden.
| | - Lotta Wikström
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, 551 85 Jönköping Sweden
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden.
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, 581 83 Linköping, Sweden; Department of Clinical Neurophysiology, University Hospital, 581 85 Linköping, Sweden.
| | - Anders Broström
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Clinical Neurophysiology, University Hospital, 581 85 Linköping, Sweden.
| |
Collapse
|
21
|
Wikström L, Eriksson K, Fridlund B, Årestedt K, Broström A. Healthcare professionals' descriptions of care experiences and actions when assessing postoperative pain - a critical incident technique analysis. Scand J Caring Sci 2015; 30:802-812. [PMID: 26709955 DOI: 10.1111/scs.12308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments. OBJECTIVES The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain. METHODS An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience. FINDINGS In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain. CONCLUSIONS Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.
Collapse
Affiliation(s)
- Lotta Wikström
- School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Kerstin Eriksson
- School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden
| | - Anders Broström
- School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden
| |
Collapse
|
22
|
Botti M, Kent B, Bucknall T, Duke M, Johnstone MJ, Considine J, Redley B, Hunter S, de Steiger R, Holcombe M, Cohen E. Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design. Implement Sci 2014; 9:110. [PMID: 25164125 PMCID: PMC4164760 DOI: 10.1186/s13012-014-0110-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/11/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described. METHODS In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed. DISCUSSION The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts.
Collapse
Affiliation(s)
- Mari Botti
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Bridie Kent
- />Plymouth University, Drake Circus, Plymouth England
| | - Tracey Bucknall
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Maxine Duke
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Megan-Jane Johnstone
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Julie Considine
- />Eastern Health/Deakin University Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Bernice Redley
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Susan Hunter
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Richard de Steiger
- />Epworth Victor Smorgon Chair of Surgery, Epworth HealthCare, 185-187 Hoddle Street, Richmond, 3121 VIC Australia
| | - Marlene Holcombe
- />Epworth HealthCare, 62 Erin Street, Richmond, 3121 VIC Australia
| | - Emma Cohen
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| |
Collapse
|
23
|
Woldehaimanot TE, Eshetie TC, Kerie MW. Postoperative pain management among surgically treated patients in an Ethiopian hospital. PLoS One 2014; 9:e102835. [PMID: 25033399 PMCID: PMC4102595 DOI: 10.1371/journal.pone.0102835] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background Incidence of postoperative pain has been reported to be between 47–100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia. Methods and Findings A prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach’s α coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients’ charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar’s; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r = 0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status. Conclusion Despite patients’ paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management.
Collapse
|
24
|
Schwenkglenks M, Gerbershagen HJ, Taylor RS, Pogatzki-Zahn E, Komann M, Rothaug J, Volk T, Yahiaoui-Doktor M, Zaslansky R, Brill S, Ullrich K, Gordon DB, Meissner W. Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry. Pain 2014; 155:1401-1411. [DOI: 10.1016/j.pain.2014.04.021] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/30/2022]
|
25
|
Herrero-Sánchez MD, García-Iñigo MDC, Nuño-Beato-Redondo BS, Fernández-de-las-Peñas C, Alburquerque-Sendín F. Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty. CIENCIA & SAUDE COLETIVA 2014; 19:1881-8. [DOI: 10.1590/1413-81232014196.04632013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/28/2013] [Indexed: 01/02/2023] Open
Abstract
The scope of this paper was to study the relationship between pain intensity, health-related quality of life, disability, sleep quality and demographic data in elderly people with total knee arthroplasty (TKA). 24 subjects who had been subjected to TKA the previous month (4 females; 66 ± 9years) and 21 comparable controls (8 male; 70 ± 9years) participated in the study. Intensity of pain, and highest and lowest pain intensity experienced in the preceding week were collected. The Western Ontario and McMaster Universities index function, quality of life (Medical Outcomes Study Short Form 36), and Pittsburgh Sleep Quality Index were assessed. Age, gender, weight, height, body mass index were also collected. Individuals with TKA presented worse physical function (P < 0.01), social role (P = 0.01), physical performance (P < 0.01), pain (P = 0.04), disability (P = 0.04) and sleep quality (P = 0.03) than the controls. Higher intensity of pain was associated with lower physical function, social role, mental health, vitality and general health, and with higher disability and sleep quality. Disability and sleep quality were negatively associated with several quality of life domains. The associations between the intensity of pain, disability, quality of life and sleep reveal the multidimensional experience of TKA.
Collapse
|
26
|
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
| |
Collapse
|
27
|
Eriksson K, Wikström L, Årestedt K, Fridlund B, Broström A. Numeric rating scale: patients' perceptions of its use in postoperative pain assessments. Appl Nurs Res 2013; 27:41-6. [PMID: 24332467 DOI: 10.1016/j.apnr.2013.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/30/2013] [Accepted: 10/28/2013] [Indexed: 11/24/2022]
Abstract
AIM The purpose of this study was to describe how patients perceive the use of the numeric rating scale in postoperative pain assessments. BACKGROUND There are recommendations to use a pain scale to follow patients' postoperative pain. Most patients prefer the NRS but there is a discrepancy between patients and healthcare professionals how to interpret the ratings from the pain assessments. METHODS A descriptive design with a phenomenographic approach was used. Semi structured interviews were held with 25 patients. RESULTS Three description categories emerged that illustrate patients' perceptions; use of the NRS facilitated communication of pain, it put demands on healthcare professionals and care routines and it contained interpretation difficulties. CONCLUSION The NRS has a place in pain management according to the patients but there is a need for a dialogue to give the patients the opportunity to describe their pain and set a common goal.
Collapse
Affiliation(s)
- Kerstin Eriksson
- School of Health Sciences, Jönköping University, Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
| | - Lotta Wikström
- School of Health Sciences, Jönköping University, Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden; Palliative Research Centre, Ersta Sköndal University College and Ersta hospital, Stockholm, Sweden.
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | - Anders Broström
- School of Health Sciences, Jönköping University, Jönköping, Sweden; Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
| |
Collapse
|
28
|
Continuous Saphenous Nerve Block as Supplement to Single-Dose Local Infiltration Analgesia for Postoperative Pain Management After Total Knee Arthroplasty. Reg Anesth Pain Med 2013; 38:106-11. [DOI: 10.1097/aap.0b013e31827900a9] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Jordanian patients' satisfaction with pain management. Pain Manag Nurs 2012; 15:116-25. [PMID: 23273825 DOI: 10.1016/j.pmn.2012.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 06/19/2012] [Accepted: 07/09/2012] [Indexed: 11/22/2022]
Abstract
Pain is still undertreated among hospitalized patients. Recently, patient satisfaction with pain management has received significant attention. This field has not yet been explored among Jordanian patients. The purpose of this study was to determine the knowledge regarding pain characteristics, beliefs, and satisfaction that can be included in planning pain management strategies and protocols within Jordanian hospitals. Using descriptive cross-sectional methodology, the American Pain Society Patient Outcome Questionnaire (APS-POQ) was used to survey 375 inpatients from Jordanian hospitals. Participants reported relatively severe pain and pain interferences while being hospitalized and seemed to be well informed regarding pain and pain management. Participants reported high levels of pain management satisfaction. Also, the Arabic version of the APS-POQ was found to be reliable among the Jordanian population. Findings of this study are similar to those reported by earlier studies in other countries and support the need for applying the caring attitude in managing patients' reports of having pain. This study is the first in Jordan, opening the door for future studies to be conducted in this important field.
Collapse
|
30
|
Zoëga S, Ward S, Gunnarsdottir S. Evaluating the quality of pain management in a hospital setting: testing the psychometric properties of the Icelandic version of the revised American Pain Society patient outcome questionnaire. Pain Manag Nurs 2012; 15:143-55. [PMID: 23318415 DOI: 10.1016/j.pmn.2012.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 11/27/2022]
Abstract
Pain management is an important aspect of providing quality health care, and monitoring patient-related outcomes is a recommended quality improvement practice. Valid and reliable tools are needed for this purpose. The American Pain Society Patient Outcome Questionnaire (APS-POQ) is widely used to measure quality of pain management. The APS-POQ was recently revised to reflect advances in pain management. The purpose of this study was to test the psychometric properties of the revised version in Icelandic patients in the hospital setting. The questionnaire was translated according to an adaptation of Brislin's model. Data were collected from 143 patients on 23 wards in a university hospital. Participants were ≥ 18 years old, hospitalized for >24 hours, alert, not too ill to participate, and in pain ≥ 1 on a 0-10 scale in the past 24 hours. Mean (SD) age was 66 (18) years, 51.4% were women, 48.6% men. Principal component analysis with varimax rotation confirmed a five-component structure, but four items lowered reliability and were removed from the scales. The final version consists of four components, with Cronbach α >.70, explaining 64.2% of the variance. Participants had little difficulty in answering the questionnaire, but two additional items about participation in decisions and pain medications were added in response to patients' comments and suggestions. Administering the Icelandic version of the APS-POQ-R was found to be feasible, and the questionnaire has acceptable construct validity and reliability. The results support the use of the APS-POQ-R-I to evaluate the quality of pain management in hospitals in Iceland.
Collapse
Affiliation(s)
- Sigridur Zoëga
- Landspítali-National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland.
| | - Sandra Ward
- School of Nursing, University of Wisconsin-Madison
| | - Sigridur Gunnarsdottir
- Landspítali-National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
31
|
Eriksson K, Wikström L, Lindblad-Fridh M, Broström A. Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery. J Clin Nurs 2012; 22:638-47. [DOI: 10.1111/j.1365-2702.2012.04225.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Pain and satisfaction in hospitalized trauma patients: the importance of self-efficacy and psychological distress. J Trauma Acute Care Surg 2012; 72:1068-77. [PMID: 22491629 DOI: 10.1097/ta.0b013e3182452df5] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unmanaged pain has been found to predict delayed return to work, psychologic distress, and chronic pain and disability in patients with traumatic injury. However, little is known about the pain experience during hospitalization. The primary objective of this study was to determine pain intensity, pain interference, and satisfaction with pain treatment in orthopedic trauma patients at hospital discharge. A secondary objective was to examine whether patient self-efficacy and psychologic distress were associated with pain and satisfaction. METHODS Two hundred thirty-three orthopedic trauma patients were enrolled and completed a discharge assessment at a Level I trauma center. Pain was measured with the Brief Pain Inventory and satisfaction with the American Pain Society Patient Outcome Questionnaire. RESULTS Ninety-seven percent of patients reported pain at the time of hospital discharge, with 59% and 73% reporting moderate to severe pain intensity and interference, respectively. Overall, 86% of patients were satisfied with pain treatment. Multivariable regression analyses demonstrated that decreased self-efficacy was associated with moderate to severe pain intensity, increased depression was associated with moderate to severe pain intensity and interference, and increased pain intensity was associated with decreased satisfaction (p < 0.05). CONCLUSIONS Results suggest that orthopedic trauma patients have a significant pain burden but are satisfied with pain treatment during the hospital stay. Efforts are needed to improve pain assessment and management and findings imply that addressing self-efficacy and depressive symptoms may decrease pain and increase satisfaction at hospital discharge. Brief educational interventions that incorporate pain coping skills and self-management techniques may be a feasible approach to improving self-efficacy in the acute care setting. Additional recommendations include routine hospital screening for depression and increased communication between surgeons and mental health providers to identify patients at high risk for unmanaged pain and facilitate provision of early mental health services.
Collapse
|
33
|
|
34
|
Lorentzen V, Hermansen I, Botti M. A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients. Eur J Pain 2012; 16:278-88. [DOI: 10.1016/j.ejpain.2011.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V. Lorentzen
- The Centre of Nursing Research - Viborg; Heibergs Alle 2; DK-8800; Viborg; Denmark
| | - I.L. Hermansen
- Department of Obstetrics and Gynaecology; Region Hospital Viborg, Skive, Kjellerup; Heibergs Alle; DK-8800; Viborg; Denmark
| | - M. Botti
- Epworth/Deakin Centre for Clinical Nursing Research; School of Nursing and Midwifery; Faculty of Health, Medicine; Nursing and Behavioural Sciences; Deakin University; 221 Burwood Highway; Burwood; Victoria; 3125; Australia
| |
Collapse
|
35
|
Zaslansky R, Chapman C, Rothaug J, Bäckström R, Brill S, Davidson E, Elessi K, Fletcher D, Fodor L, Karanja E, Konrad C, Kopf A, Leykin Y, Lipman A, Puig M, Rawal N, Schug S, Ullrich K, Volk T, Meissner W. Feasibility of international data collection and feedback on post-operative pain data: Proof of concept. Eur J Pain 2011; 16:430-8. [DOI: 10.1002/j.1532-2149.2011.00024.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2011] [Indexed: 11/05/2022]
Affiliation(s)
- R. Zaslansky
- Department of Anesthesiology and Intensive Care; Friedrich-Schiller University Hospital; Jena; Germany
| | - C.R. Chapman
- Pain Research Center; Department of Anesthesiology; University of Utah; Salt Lake City; UT; USA
| | - J. Rothaug
- Department of Anesthesiology and Intensive Care; Friedrich-Schiller University Hospital; Jena; Germany
| | - R. Bäckström
- Department of Anesthesiology and Intensive Care; University Hospital Örebro; Örebro; Sweden
| | - S. Brill
- Department of Anesthesiology and Intensive Care; Sourasky Medical Center; Tel-Aviv; Israel
| | - E. Davidson
- Department of Anesthesiology and Intensive Care; Hadassah Medical Center; Jerusalem; Israel
| | - K. Elessi
- El-Wafa Medical Rehabilitation Hospital; Gaza Strip
| | - D. Fletcher
- Department of Anesthesiology and Intensive Care; Raymond Poincaré Hospital; Garches; France
| | - L. Fodor
- Plastic and Reconstructive Surgery; Cluj University Hospital; Cluj; Romania
| | - E. Karanja
- Doctor's Service; Avenue Hospital; Nairobi; Kenya
| | - C. Konrad
- Department of Anesthesiology and Intensive Care; Kantonsspital; Lucerne; Switzerland
| | - A. Kopf
- Department of Anesthesiology and Intensive Care; Charite Medical Center; Berlin; Germany
| | - Y. Leykin
- Department of Anesthesiology and Intensive Care; Santa Maria Degli Angeli; University of Trieste and Udine; Udine; Italy
| | - A. Lipman
- Department of Pharmacotherapy; College of Pharmacy; University of Utah; Salt Lake City; UT; USA
| | - M. Puig
- Department of Anesthesiology and Intensive Care; IMIM-Hospital del Mar-UAB; Barcelona; Spain
| | - N. Rawal
- Department of Anesthesiology and Intensive Care; University Hospital Örebro; Örebro; Sweden
| | - S. Schug
- Department of Anesthesiology and Intensive Care; University of Western Australia and Royal Perth Hospital; Perth; Australia
| | - K. Ullrich
- Department of Anesthesiology and Intensive Care; Queen Mary and Westfield College; University of London; London; UK
| | - T. Volk
- Department of Anesthesiology and Intensive Care; Saarland University Hospital; Homburg; Germany
| | - W. Meissner
- Department of Anesthesiology and Intensive Care; Friedrich-Schiller University Hospital; Jena; Germany
| |
Collapse
|
36
|
Wylde V, Rooker J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res 2011; 97:139-44. [PMID: 21388906 DOI: 10.1016/j.otsr.2010.12.003] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/25/2010] [Accepted: 12/20/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of acute postoperative pain poses a significant challenge in surgical specialities. Despite the prevalence and impact of acute postoperative pain, there is a paucity of published data regarding its occurrence and sensory qualities after joint replacement. HYPOTHESIS That a proportion of patients would experience severe acute postoperative pain at rest after total hip replacement (THR) and total knee replacement (TKR). MATERIALS AND METHODS Pain was assessed preoperatively, and then five times daily for the first three postoperative days in 105 THR and TKR patients. Pain severity was assessed using a pain Visual Analogue Scale and the sensory qualities of pain were assessed using the pain descriptors from the Short-Form McGill Pain Questionnaire. RESULTS Median acute pain scores peaked on the first postoperative day, with 58% of TKR patients and 47% of THR patients reporting moderate-severe pain. Preoperative pain was most frequently described as aching, stabbing and sharp, whereas acute postoperative pain was described as aching, heavy and tender. Night pain disturbed between 44-57% of TKR patients and 21-52% of THR patients on postoperative nights 1-3. DISCUSSION These findings demonstrate that acute postoperative pain at rest after joint replacement, particularly TKR, is poorly managed, although it does not reach the severity of preoperative pain. LEVEL OF EVIDENCE Level IV (observational cohort study).
Collapse
Affiliation(s)
- V Wylde
- Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre (lower level), Southmead Hospital, BS10 5NB, Bristol, United Kingdom.
| | | | | | | |
Collapse
|
37
|
Crawford FIJ, Armstrong D, Boardman C, Coulthard P. Reducing postoperative pain by changing the process. Br J Oral Maxillofac Surg 2010; 49:459-63. [PMID: 20728969 DOI: 10.1016/j.bjoms.2010.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 07/23/2010] [Indexed: 11/26/2022]
Abstract
Untreated postoperative pain is an important ethical and financial issue that can lead to unnecessary suffering and prolonged stays in hospital. Despite the availability of effective analgesics and a growing body of published material that supports their use, postoperative pain remains a problem worldwide. To reduce acute postoperative pain, we introduced an intervention combining evidence-based analgesic protocols with the education of staff and patients on a surgical ward. The experiences of 68 patients before and 80 patients after the intervention were compared (worst pain scores, duration of pain, and satisfaction). Inadequately controlled pain was significantly reduced after the intervention, which suggests that the introduction of analgesic protocols supported by the education of staff and patients can be beneficial. Despite this, severe pain remained relatively common, indicating room for improvement. Duration of pain and patient satisfaction were not affected by the intervention, and patient satisfaction remained high throughout the study.
Collapse
Affiliation(s)
- F I J Crawford
- School of Dentistry, The University of Manchester, Manchester Academic Health Science Centre, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UK
| | | | | | | |
Collapse
|
38
|
Pain Prevalence Study in a Large Canadian Teaching Hospital. Round 2: Lessons Learned? Pain Manag Nurs 2010; 11:45-55. [DOI: 10.1016/j.pmn.2009.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 01/19/2009] [Accepted: 01/26/2009] [Indexed: 11/15/2022]
|
39
|
Mira JJ, Tomás O, Virtudes-Pérez M, Nebot C, Rodríguez-Marín J. Predictors of patient satisfaction in surgery. Surgery 2009; 145:536-41. [PMID: 19375613 DOI: 10.1016/j.surg.2009.01.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 01/15/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to evaluate the satisfaction of surgical patients in order to identify predictors of patient satisfaction, using a cross-sectional surgery patients' survey in 24 public hospitals in Spain and a total of 15,539 inpatients and 7,899 outpatients. RESULTS Seventy-seven percent of inpatients and 88.3% of outpatients were satisfied (chi(2) = 509.31; P < .0001). Case-mix and hospital size were associated with satisfaction in inpatients (chi(2) = 19.31; P = .013). Older inpatients tended to be more satisfied (chi(2) = 80.54; P = .001), whereas; younger outpatients showed higher satisfaction levels (chi(2) = 51.73; P = .004). The most influential factors on inpatient satisfaction were information at admission (odds ratio [OR], 4.05; 95% confidence interval [CI], 2.91-5.63), knowing what type of professional one was dealing with at any given time (OR, 4.01; 95% CI, 3.01-5.34), and informed consent (OR, 3.37; 95% CI, 2.41-4.71). For outpatients, the most influential factors were informed consent (OR, 7.62; 95% CI, 3.68-15.80) and information about home care after discharge (OR, 7.010; 95% CI, 3.06-15.96). CONCLUSION We should consider the importance of patient information before and after treatment in the design of clinical pathways to offer better and more comprehensive care to surgical patients.
Collapse
|
40
|
Meissner W, Mescha S, Rothaug J, Zwacka S, Goettermann A, Ulrich K, Schleppers A. Quality improvement in postoperative pain management: results from the QUIPS project. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:865-70. [PMID: 19561807 DOI: 10.3238/arztebl.2008.0865] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/30/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acute postoperative pain management is still far from satisfactory despite the availability of high-quality guidelines and advanced pain management techniques. METHODS An outcome-oriented project called QUIPS (Quality Improvement in Postoperative Pain Management) was developed, consisting of standardized data acquisition and an analysis of quality and process indicators. RESULTS After validation of the questionnaire, a total of 12 389 data sets were collected from 30 departments in six participating hospitals. Improved outcomes (reduction in pain intensity) were observed in four of the six hospitals. The most painful operations, in the patients' judgment, were traumatological and orthopedic procedures, as well as laparoscopic appendectomy. Traditional process indicators, such as routine pain documentation, were only poorly correlated with outcomes. DISCUSSION QUIPS shows that outcomes in postoperative pain management can be measured and compared in routine clinical practice. This may lead to improved care. QUIPS reveals which operations are the most painful. Quality improvement initiatives should use as few resources as possible, measure the quality of the outcomes, and provide rapid feedback. Structural and process parameters should be continuously reevaluated to determine their suitability as indicators of quality.
Collapse
Affiliation(s)
- Winfried Meissner
- Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena, Jena, Germany.
| | | | | | | | | | | | | |
Collapse
|
41
|
Dihle A, Helseth S, Christophersen KA. The Norwegian version of the American Pain Society Patient Outcome Questionnaire: reliability and validity of three subscales. J Clin Nurs 2008; 17:2070-8. [PMID: 18720561 DOI: 10.1111/j.1365-2702.2007.02142.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine some psychometric properties of the Norwegian version of the American Pain Society's Patient Outcome Questionnaire(APS-POQ-N). BACKGROUND This study is part of an investigation of Norwegian orthopaedic surgical patients, where the overall aim is to evaluate the quality of postoperative pain management. Therefore, an adequate questionnaire on the quality of postoperative pain management was needed. METHODS The sample included 114 orthopaedic postoperative patients. The instrument consists of three main subscales, namely the modified Brief Pain Inventory(modified BPI subscale), the subscale on satisfaction with pain management(Satisfaction subscale) and the subscale on beliefs about pain management (Beliefs subscale), together with six single items about pain management. The reliability of these three main subscales was estimated using Cronbach's alpha coefficients and the construct validity was evaluated using principal-axis factor analysis with oblimin rotation. RESULTS Face and content validity of the APS-POQ-N were satisfactory, while the modified BPI and the Beliefs subscales showed acceptable internal consistency but the Satisfaction subscale did not. Factor analyses yielded a three-factor solution for the modified BPI, a one-factor solution for the Satisfaction subscale and a two-factor solution for the Beliefs subscale. CONCLUSIONS The APS-POQ-N appears, in general, to be an acceptable method of evaluating postoperative pain management in orthopaedic postoperative patients.However, the alpha value of the Satisfaction subscale was low, and thus the subscale is not recommended for this purpose.
Collapse
Affiliation(s)
- Alfhild Dihle
- Faculty of Nursing, Oslo University College, Oslo, Norway.
| | | | | |
Collapse
|
42
|
Qu Shen, Sherwood GD, McNeill JA, Zheng Li. Postoperative Pain Management Outcome in Chinese Inpatients. West J Nurs Res 2008; 30:975-90. [DOI: 10.1177/0193945908319576] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the absence of pain management outcome reports representing mainland China, the purposes of this study were to describe the outcome of postoperative pain management and the relationship between patient satisfaction and clinical outcomes in an indigenous Chinese population. From a sample of 388 second-day-postoperative inpatients, 304 (78%) reported pain in the past 24 hours and were enrolled in the study. Mean ratings for pain were moderate to severe. Patients reported mild to moderate pain-related interference with mood and physical activities. There were significant differences on worst pain intensity and pain interference with daily activity in the past 24 hours for different types of surgery. Top-ranked nonpharmacologic methods for managing pain were tolerating pain, changing positions, and family support. As measured by the Pain Management Index, 60.2% of patients were inadequately treated for pain, yet patients reported high satisfaction with pain management. Patient satisfaction, however, was inversely and significantly correlated with pain intensity. Study results indicate a need for standardized policies and guidelines about pain management and education among providers and for patients and families to overcome the suboptimal pain outcomes among this Chinese population.
Collapse
Affiliation(s)
- Qu Shen
- Xiamen University Medical College
| | | | | | - Zheng Li
- Peking Union Medical College School of Nursing,
| |
Collapse
|
43
|
An evaluation of postoperative epidural analgesia in acute pain service in an Indian cancer hospital (a preliminary experience of patient satisfaction survey). ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.acpain.2007.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
44
|
Dihle A, Helseth S, Paul SM, Miaskowski C. The Exploration of the Establishment of Cutpoints to Categorize the Severity of Acute Postoperative Pain. Clin J Pain 2006; 22:617-24. [PMID: 16926577 DOI: 10.1097/01.ajp.0000210905.57546.c1] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although several studies have established different cutpoints (CPs) for mild, moderate, and severe pain for a variety of chronic pain conditions, only one study by Mendoza and colleagues reported on CPs for acute postoperative pain that were derived using ratings of worst pain. The purpose of this study was to explore the establishment of the optimal CPs for mild, moderate, and severe postoperative pain using ratings of average and worst pain and to determine if these CPs distinguished among the pain severity groups on several outcomes. METHODS The study is a reanalysis of data from patients who underwent hip and knee replacement surgery. Using the methodology described by Serlin et al, a series of CP derivations were performed based on both single item scores for pain intensity and mean scores for pain intensity. One-way analyses of variance, chi analyses, or Kruskal-Wallis tests were conducted to determine if the optimal CPs for pain severity distinguished among the 3 pain severity groups on several outcomes. RESULTS CPs 3,5 were found using a mean score based on patients' ratings of average and worst pain on the third postoperative day. Findings suggest that mean pain scores of >3 have a significant effect on general activity, mood, walking ability, and sleep. DISCUSSION Possible explanations for the differences in the CPs found in this study compared with the results by Mendoza and colleagues are discussed. The findings warrant replication in other samples of postoperative patients.
Collapse
Affiliation(s)
- Alfhild Dihle
- Faculty of Nursing, Oslo University College, Oslo, Norway.
| | | | | | | |
Collapse
|