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Jin Y, Yu X, Li J, Su M, Li X. Causal effects and immune cell mediators between prescription analgesic use and risk of infectious diseases: a Mendelian randomization study. Front Immunol 2023; 14:1319127. [PMID: 38193081 PMCID: PMC10772142 DOI: 10.3389/fimmu.2023.1319127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Clinical observations have found that prolonged use of analgesics increases the incidence of infection. However, the direct causal relationship between prescription analgesic use (PAU) and risk of infection (ROI) remains unclear. Methods This study used Mendelian randomization (MR) design to estimate the causal effect of PAU on ROI, as well as their mediating factors. Genetic data on prescription analgesics use and immune cells were obtained from published GWAS. Additionally, data on ROI were extracted from the FinnGen database. Two-sample MR analysis and multivariate MR (MVMR) analysis were performed using inverse variance weighting (IVW) to ascertain the causal association between PAU and ROI. Finally, 731 immune cell phenotypes were analyzed for their mediating role between analgesics and infection. Results Using two-sample MR, IVW modeling showed that genetically predicted opioid use was associated with increased risk of pulmonary infection (PI) (OR = 1.13, 95% CI: 1.05-1.21, p< 0.001) and upper respiratory infection (URI) (OR = 1.18, 95% CI: 1.08-1.30, p< 0.001); non-steroidal anti-inflammatory drugs (NSAIDs) were related to increased risk of skin and subcutaneous tissue infection (OR = 1.21, 95% CI: 1.05-1.39, p = 0.007), and antimigraine preparations were linked to a reduced risk of virus hepatitis (OR = 0.79, 95% CI: 0.69-0.91, p< 0.001). In MVMR, the association of opioids with URI and PI remained after accounting for cancer conditions. Even with a stricter threshold (p< 0.05/30), we found a significant causal association between opioids and respiratory infections (URI/PI). Finally, mediation analyses found that analgesics influence the ROI through different phenotypes of immune cells as mediators. Conclusion This MR study provides new genetic evidence for the causal relationship between PAU and ROI, and the mediating role of immune cells was demonstrated.
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Affiliation(s)
- Yi Jin
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xinghao Yu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jun Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Mingzhu Su
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaomin Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
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Becerra-Bolaños Á, Armas-Domínguez A, Valencia L, Jiménez-Marrero P, López-Ruiz S, Rodríguez-Pérez A. Pain Prevalence and Satisfaction with Pain Management in Inpatients: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:3191. [PMID: 38132081 PMCID: PMC10743299 DOI: 10.3390/healthcare11243191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Pain in hospitalized adults is underestimated and undervalued. The aim of this study was to evaluate pain prevalence and satisfaction with the hospital's pain management among patients attending a tertiary university hospital. Predictor factors of pain were also studied. METHODS A prospective, cross-sectional study was carried out through a structured questionnaire given on one day to all hospitalized patients in a university hospital. Clinical data, such as personal history and analgesic treatment, were collected from medical records. Other variables related to pain (including intensity rated by the visual analogue scale as well as location and patient satisfaction measured by the numerical rating scale) were also obtained. RESULTS Of the 274 surveyed patients, pain prevalence was 52.9%, with an average intensity of 5.3 ± 2.8 according to VAS. The overall satisfaction was 87.2%, and 72.6% had already been prescribed at least one analgesic. Patients receiving analgesics showed higher pain intensity (VAS 3.6 ± 3.4) than those without treatment (VAS 1.1 ± 2.1) (p < 0.001). However, patients with treatment showed more satisfaction (NRS 7.8 ± 2 vs. 5.3 ± 1.4, p < 0.001). CONCLUSIONS The prevalence of pain in hospitalized patients was high, despite the fact that patient satisfaction was also very high.
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Affiliation(s)
- Ángel Becerra-Bolaños
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Annette Armas-Domínguez
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Lucía Valencia
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.R.-P.)
| | - Pedro Jiménez-Marrero
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.R.-P.)
| | - Sergio López-Ruiz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.R.-P.)
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
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Peterson A, Schaller AS. How Hospital Patients Experience Pain the Previous 24 Hours-A Prevalence Assessment of Pain in Five Hospitals in Sweden. Pain Manag Nurs 2022; 23:878-884. [PMID: 36075787 DOI: 10.1016/j.pmn.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/23/2022] [Accepted: 07/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous studies show that pain is common among hospital inpatients. AIM This study measures the prevalence of pain and the impact of pain on sleep in patients admitted to five hospitals in Sweden. METHODS The patients were admitted to a surgical or a medical ward. They answered on a self-reported questionnaire about their average pain intensity and how much their pain interfered with their sleep the previous 24 hours, on a 010 numerical rating scale (NRS). RESULTS Of the 500 patients, 308 experienced pain (62%), (NRS ≥ 3) and 111 (22%) rated their pain as NRS ≥ 7. We found no difference between surgical and medical specialty regarding pain prevalence. The results suggest that roughly the same proportion of patients with pain also experienced poor sleep due to pain265 patients (53%) reported pain interference on sleep, NRS ≥ 3. CONCLUSIONS AND CLINICAL IMPLICATIONS This study shows that there is still an unacceptable high pain prevalence in inpatients and that patients experience pain as negatively impacting their sleep. Future pain care is likely to include a more comprehensive implementation strategy for the dissemination of knowledge, especially related to the complex context of today's healthcare system. That is, the possibility that anchoring new knowledge also benefits the patient is probably associated with optimization of the structural context. Future research should take this question further by examining how the organizational structure should be optimized for the dissemination of knowledge in healthcare professionals about pain and pain interference with sleep.
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Affiliation(s)
- Anna Peterson
- ain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anne Söderlund Schaller
- ain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Mackintosh-Franklin C. Recognising and assessing acute pain. Nurs Stand 2021; 36:61-66. [PMID: 33269844 DOI: 10.7748/ns.2020.e11501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care.
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Fernández-Castro M, Martín-Gil B, López M, Jiménez JM, Liébana-Presa C, Fernández-Martínez E. Factors Relating to Nurses' Knowledge and Attitudes Regarding Pain Management in Inpatients. Pain Manag Nurs 2021; 22:478-484. [PMID: 33483256 DOI: 10.1016/j.pmn.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe factors associated with nurses' attitudes or lack of knowledge regarding pain management in adult inpatients. DESIGN Transverse descriptive survey-based study. METHODS This was a transverse descriptive survey-based study. The population was obtained through nonprobabilistic convenience sampling. The Knowledge and Attitudes Survey Regarding Pain was made available to 470 nurses at a tertiary level hospital. Associations were sought with the unit where assigned, years of experience, specific training on pain, and postgraduate education. RESULTS The sample included 134 nurses with a mean age of 41.6 ± 10.8 years; 87% were women, 64% worked rotating shifts, 64% had more than 10 years of experience, and 31% had specific training in pain management. The greatest number of correct responses was obtained from nurses with specific training in pain management (p = .001) and nurses who worked in units of surgical hospitalization (p = .004). The lack of training was associated with a deficit in knowledge and inadequate attitudes about pain management. In nurses with less than 10 years of experience, worse results were observed in knowledge, whereas the unit of work was decisive in the results about attitude (p < .05). CONCLUSIONS Among the nurses surveyed, some knowledge gaps were detected, as were certain inappropriate attitudes, associated with lack of training, lack of experience, and being assigned to specific hospitalization units.
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Affiliation(s)
| | - Belén Martín-Gil
- Nursing Care Information Systems, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María López
- Universidad de Valladolid, Facultad de Enfermería de Valladolid, Valladolid, Spain.
| | - José María Jiménez
- Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid, Valladolid, Spain.
| | - Cristina Liébana-Presa
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, León, Spain
| | - Elena Fernández-Martínez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, León, Spain
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Jackson HJ, Reneau M. Complementary therapies for acute pain management: What does the evidence say? Nurse Pract 2019; 44:8-11. [PMID: 31764469 DOI: 10.1097/01.npr.0000605532.19434.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Heather J Jackson
- Heather J. Jackson is an NP and administrative director of advanced practice, Vanderbilt Ingram Cancer Center and associate in anesthesiology, pain division at Vanderbilt University Medical Center, Nashville, Tenn. Marcelaine Reneau is an NP at Ralph H. Johnson Veterans Administration Medical Center, Integrative Pain Clinic, Department of Anesthesia, Charleston, S.C
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Schlegelmilch M, Punja S, Jou H, Mackie AS, Conway J, Wilson B, Spavor M, Hartfield D, Vohra S. Observational Study of Pediatric Inpatient Pain, Nausea/Vomiting and Anxiety. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E65. [PMID: 31058878 PMCID: PMC6560414 DOI: 10.3390/children6050065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 01/02/2023]
Abstract
Background: The prevalence and severity of pain, nausea/vomiting, and anxiety (PNVA) among hospitalized children is not well established. We describe the prevalence and severity of PNVA among hospitalized patients from oncology, general pediatrics, and cardiology services in a tertiary care center. Methods: Patients were recruited on admission and enrolled if their caregiver consented, spoke English, and were anticipated to stay 2-30 days. Symptoms were measured weekdays using age-validated tools. PNVA symptoms were described and compared. Results: We enrolled 496 (49.4%) patients of 1005 admitted. Patients were predominantly Caucasian (57.9%) on their first admission (53.6%). The average (SD) age was 8.6 years (5.9) in oncology, 4.2 (5.3) in general pediatrics and 2.6 (4.0) in cardiology. 325 (65.6%) patients reported anxiety, 275 (55.4%) reported nausea and 256 (52.0%) reported pain. Mean (SD) severity out of 10 was 3.7 (2.5) for anxiety, 3.2 (2.1) for nausea and 3.0 (1.5) for pain. Prevalence of PNVA was no different between clinical programs, but pain (p = 0.008) and nausea (p = 0.006) severity were. PNVA symptom co-occurrence was positively correlated (p < 0.001). Conclusions: Anxiety was the most common and severe symptom for hospitalized children. Patients in oncology demonstrated the least severe pain and nausea with no difference in anxiety between services.
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Affiliation(s)
- Michael Schlegelmilch
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
| | - Salima Punja
- University of Alberta, Integrative Health Institute, Edmonton, AB , T6G 2C8, Canada.
| | - Hsing Jou
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
- University of Alberta, Integrative Health Institute, Edmonton, AB , T6G 2C8, Canada.
| | - Andrew S Mackie
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
| | - Jennifer Conway
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
| | - Bev Wilson
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
| | - Maria Spavor
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
| | - Dawn Hartfield
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
| | - Sunita Vohra
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB , T6G 2R3, Canada.
- University of Alberta, Integrative Health Institute, Edmonton, AB , T6G 2C8, Canada.
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Peterson A, Berggården M, Schaller AS, Larsson B. Nurses’ Advocacy of Clinical Pain Management in Hospitals: A Qualitative Study. Pain Manag Nurs 2019; 20:133-139. [DOI: 10.1016/j.pmn.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/25/2018] [Accepted: 09/01/2018] [Indexed: 01/08/2023]
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Muñoz-Alvaredo L, López Vallecillo M, Jiménez Pérez JM, Martín-Gil B, Muñoz Moreno MF, Fernández-Castro M. Prevalence, pain management and registration in Internal Medicine units. ENFERMERIA CLINICA 2019; 30:275-281. [PMID: 30598350 DOI: 10.1016/j.enfcli.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of Castilla y León. METHOD A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records. RESULTS 83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale. CONCLUSIONS There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.
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Affiliation(s)
- Laura Muñoz-Alvaredo
- Unidad de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - María López Vallecillo
- Unidad de Gestión de Cuidados Gacela, Hospital Clínico Universitario de Valladolid, Valladolid, España; Facultad de Enfermería, Universidad de Valladolid, Valladolid, España
| | | | - Belén Martín-Gil
- Unidad de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Fe Muñoz Moreno
- Estadística, Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Mercedes Fernández-Castro
- Sección de Enfermería, Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España.
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Marquini GV, Pinheiro FES, Vieira AUC, Pinto RMC, Uyeda MGBK, Girão MJBC, Sartori MGF. Efeitos da abreviação do jejum pré-operatório com solução de carboidrato e proteína em sintomas pós-operatórios de cirurgias ginecológicas: ensaio clínico randomizado controlado duplo-cego. Rev Col Bras Cir 2019; 46:e20192295. [DOI: 10.1590/0100-6991e-20192295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/10/2019] [Indexed: 12/20/2022] Open
Abstract
RESUMO Objetivo: investigar os efeitos da abreviação do jejum pré-operatório, uma recomendação do protocolo de “Aceleração da Recuperação Total Pós-operatória” (ACERTO), em sintomas pós-operatórios de pacientes submetidas à cirurgias ginecológicas. Métodos: estudo controlado, randomizado, duplo-cego, de 80 cirurgias ginecológicas realizadas no período de janeiro a junho de 2016. As pacientes foram aleatoriamente alocadas em dois grupos: Grupo Controle, com 42 pacientes, e Grupo Suco, com 38, e que receberam, respectivamente, 200ml de solução inerte ou 200ml de líquido enriquecido com carboidrato e proteína quatro horas antes da cirurgia. Os sintomas pós-operatórios estudados foram sede, fome, dor, agitação, satisfação e bem-estar, em ambos os grupos. Para medir a intensidade dos sintomas foi utilizada a Escala Visual Analógica (EVA), associada à Escala Facial (EF) para dor, aplicadas dez horas após a cirurgia. Resultados: as pacientes do Grupo Suco apresentaram menos dor (3,51x1,59), sede (3,63x0,85), fome (3,86x2,09) e agitação (2,54x0,82) em relação ao Grupo Controle (P<0,05). As variáveis satisfação (6,89x8,68) e bem-estar (5,51x7,12) foram maiores (P<0,05) quando houve a ingestão do líquido contendo carboidrato e proteína (Grupo Suco) em relação à solução inerte (Grupo Controle). Conclusão: a abreviação do jejum pré-operatório com líquido contendo carboidrato e proteína antes de cirurgias ginecológicas reduz sede, fome, dor, agitação e favorece maior satisfação e bem-estar do que a ingestão de solução inerte.
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Xiao H, Liu H, Liu J, Zuo Y, Liu L, Zhu H, Yin Y, Song L, Yang B, Li J, Ye L. Pain Prevalence and Pain Management in a Chinese Hospital. Med Sci Monit 2018; 24:7809-7819. [PMID: 30382075 PMCID: PMC6225731 DOI: 10.12659/msm.912273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Pain prevalence has been investigation in many developed countries, but integrated information about pain prevalence in Chinese hospitals is lacking. To achieve better pain treatment of hospitalized patients, pain management needs to be investigated. The present descriptive and cross-sectional study was performed to demonstrate the prevalence of pain by comparison with the 4 traditional vital signs, and to investigate pain management in a Chinese teaching hospital. Material/Methods Structured and systematic interviews were undertaken by independent researchers. During a patient’s hospitalization, the prevalence of pain and the 4 vital signs were recorded. Then, the catalog, severity, causes, duration of pain, and pain management were assessed. Results We found: (1) 63.36% of patients (3248 in total) suffered from pain while in hospital, which was 1.8~2.8 times higher than the prevalence of abnormality of the 4 vital signs. (2) 76% of patients had moderate pain and 21.98% had severe pain. (3) Pain intensity differed among patients with different diseases, but did not differ by demographic factors. (4) Acute and chronic pain were present in 68% and 26% of patients, respectively. In addition, 16% of the patients had neuropathic pain. (5) More than half of the patients with pain refused to receive pain-relief medication because they worried about addiction to opioids and the adverse effects of analgesics. (6) Most medical staff properly understood the 3 ladder analgesics. Conclusions The prevalence of pain is higher than the abnormality of the 4 traditional vital signs in a Chinese hospital. Although pain management has broadly improved, more patient education is necessary.
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Affiliation(s)
- Hong Xiao
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hui Liu
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Li Liu
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hong Zhu
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yan Yin
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Li Song
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Bangxiang Yang
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jun Li
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Ling Ye
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
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Mackintosh-Franklin C. Prevention of chronic pain: an acute pain management imperative. Int J Orthop Trauma Nurs 2018; 31:1-2. [PMID: 30228042 DOI: 10.1016/j.ijotn.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Peterson A, Carlfjord S, Schaller A, Gerdle B, Larsson B. Using education and support strategies to improve the way nurses assess regular and transient pain – A quality improvement study of three hospitals. Scand J Pain 2017; 16:15-21. [DOI: 10.1016/j.sjpain.2017.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
Abstract
Background and aims
Systematic and regular pain assessment has been shown to improve pain management. Well-functioning pain assessments require using strategies informed by well-established theory. This study evaluates documented pain assessments reported in medical records and by patients, including reassessment using a Numeric Rating Scale (NRS) after patients receive rescue medication.
Methods
Documentation surveys (DS) and patient surveys (PS) were performed at baseline (BL), after six months, and after 12 months in 44 in-patient wards at the three hospitals in Östergötland County, Sweden. Nurses and nurse assistants received training on pain assessment and support. The Knowledge to Action Framework guided the implementation of new routines.
Results
According to DS pain assessment using NRS, pain assessment increased significantly: from 7% at baseline to 36% at 12 months (p < 0.001). For PS, corresponding numbers were 33% and 50% (p < 0.001). According to the PS, the proportion of patients who received rescue medication and who had been reassessed increased from 73% to 86% (p = 0.003). The use of NRS to document pain assessment after patients received rescue medication increased significantly (4% vs. 17%; p < 0.001).
Conclusions
After implementing education and support strategies, systematic pain assessment increased, an encouraging finding considering the complex contexts of in-patient facilities. However, the achieved assessment levels and especially reassessments related to rescue medication were clinically unsatisfactory. Future studies should include nursing staff and physicians and increase interactivity such as providing online education support. A discrepancy between documented and reported reassessment in association with given rescue medication might indicate that nurses need better ways to provide pain relief.
Implications
The fairly low level of patient-reported pain via NRS and documented use of NRS before and 12 months after the educational programme stresses the need for education on pain management in nursing education. Implementations differing from traditional educational attempts such as interactive implementations might complement educational programmes given at the work place. Standardized routines for pain management that include the possibility for nurses to deliver pain medication within well-defined margins might improve pain management and increase the use of pain assessments. Further research is needed that examines the large discrepancy between patient-reported pain management and documentation in the medical recording system of transient pain.
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Affiliation(s)
- Anna Peterson
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden
| | - Siw Carlfjord
- Division of Community Medicine , Department of Medical and Health Sciences , Linköping University , SE 581 85 Linköping , Sweden
| | - Anne Schaller
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden
- Division of Community Medicine , Department of Medical and Health Sciences , Linköping University , SE 581 85 Linköping , Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden
- Division of Community Medicine , Department of Medical and Health Sciences , Linköping University , SE 581 85 Linköping , Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre and Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden
- Division of Community Medicine , Department of Medical and Health Sciences , Linköping University , SE 581 85 Linköping , Sweden
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14
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Mackintosh-Franklin C. Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom. NURSE EDUCATION TODAY 2017; 48:84-89. [PMID: 27723538 DOI: 10.1016/j.nedt.2016.08.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/15/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Pain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering. Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management. DESIGN A three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool. RESULTS The word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes. CONCLUSION In spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education.
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15
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Ludvigsen ES, Flaeten ØØ, Gay CL, TarAngen M, Granheim TI, Lerdal A. Pain and concomitant symptoms in medical and elective surgical inpatients: a point prevalence survey. J Clin Nurs 2016; 25:3229-3240. [DOI: 10.1111/jocn.13346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Caryl L Gay
- Department of Family Health Care Nursing; School of Nursing; University of California; San Francisco CA USA
- Department
of Patient Safety and Research; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Magnus TarAngen
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | | | - Anners Lerdal
- Department
of Patient Safety and Research; Lovisenberg Diakonale Hospital; Oslo Norway
- Department of Nursing Science; Faculty of Medicine; Institute of Health and Society; University of Oslo; Oslo Norway
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16
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Characteristics of Patients with Lower Extremity Trauma with Improved and Not Improved Pain During Hospitalization: A Pilot Study. Pain Manag Nurs 2015; 17:3-13. [PMID: 26545732 DOI: 10.1016/j.pmn.2015.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/13/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
Abstract
Up to 62% of patients report chronic pain at the injury site 6-12 months after blunt trauma, with pain from lower extremity fractures exceeding that from other sites. High pain intensity at time of injury is a risk factor for chronic pain, but it is not clear what patient characteristics influence the pain intensity level during the immediate hospitalization following injury. The purpose of this pilot study was to determine the feasibility of collecting pain scores from medical records to calculate pain trajectories and to determine whether it is possible to examine patient characteristics by classifying them into those whose pain improved and those whose pain did not improve. This descriptive study retrospectively reviewed medical records of 18 randomly chosen patients admitted to an academic trauma center. Patient characteristics and pain scores were collected form electronic and handwritten medical records. The pain trajectories calculated from routinely collected pain scores during the inpatient stay showed that for 44% of patients the pain improved during the hospitalization, for 39% the pain remained the same, and for 17% the pain worsened. The variables age, smoking, weight, abbreviated injury scores, length of hospital stay, mean pain score, and opioid equianalgesic dose differed based on pain trajectory. While patient characteristics differed based on pain trajectory, any significant effects seen from individual tests should be considered tentative, given the number of analyses conducted on this data set. However, feasibility and significance of conducting a larger study has been established.
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