American Society for Pain Management Nursing Position Statement: Prescribing and Administering Opioid Doses Based Solely on Pain Intensity

Use of Goals in Cancer Pain Management: A Systematic Review

CONTEXT

Cancer pain is multidimensional and management should be individualized to patient goals. The current standard for pain goal assessment is the personal pain goal (PPG), a numeric rating for tolerable pain intensity. However, the PPG may not accurately capture a personally meaningful goal for tailoring pain management.

OBJECTIVES

Identify how pain goals are used in cancer pain management and types of goals researched.

METHODS

CINAHL, PsychInfo, and PubMed databases and manual searching were used to locate research or scholarship about cancer pain goals. Authors reviewed titles, abstracts and full text to agree on the final sample.

RESULTS

Sixteen articles met inclusion criteria. Study designs included: quality improvement project (1), concept analysis (1), qualitative methods (5), quantitative methods (8), and mixed methods (1). Findings included: goal setting as a key attribute of pain management; achieving personal goals as the outcome of pain management work; qualitative themes discussed personal goals related to pain management; developing a patient pain management resource including a SMART goal; using motivational interviewing to set functional pain goals; PPG assessment was feasible; and achieving PPG equated to having controlled pain when compared to the clinically important difference measure used in research (≥30%). Quantitative studies reported on PPGs only.

CONCLUSION

Currently, assessments for cancer pain goals do not include function, activities, moods, medication effects, or safety that patients wish to achieve as a pain management outcome. Development and testing of multidimensional patient pain goals assessments is warranted so that goals can be consistently assessed, documented, and personally meaningful.

Post-operative pain management by nurses in an intensive care unit: a best practice implementation project

INTRODUCTION

Post-operative pain is the most prevalent type of acute pain. Nurses are the health care professionals who most frequently assess pain, as well as evaluating the patient's response to pain management treatment and monitoring for the occurrence of adverse events. Thus, to improve outcomes and quality of care, the interventions used by nurses should be based on best practices.

OBJECTIVES

The aim of this project was to implement best practices in post-operative pain management in an intensive care unit.

METHODS

This evidence implementation project was conducted in a hospital for the surgical treatment of orthopedic diseases and trauma. The project followed the JBI evidence implementation framework. The project used JBI PACES software as well as JBI's Getting Research into Practice (GRiP) audit and feedback tools to develop eight audit criteria for the baseline and follow-up audits.

RESULTS

The baseline audit showed that criteria 3 and 6 had low compliance, with few patients having documented plans and goals, and receiving multimodal analgesia in the ICU, respectively. Criteria 7 and 8, which assessed the use of opioids and follow-up by a pain specialist, revealed compliance of 60% and 50%, respectively. Criterion 3 improved from 0% to 20%. Criteria 6, 7, and 8 also improved, rising to 30%, 22.8%, and 50%, respectively.

CONCLUSION

The project improved compliance with best practices in post-operative pain management. Further studies are needed to ensure the project's long-term sustainability.

The Effect of Hand Reflexology Massage on Pain and Anxiety After Coronary Artery Bypass Graft Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

BACKGROUND

Pain and anxiety are common postoperative problems that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. Reflexology is a nonpharmacologic method used to control pain and anxiety.

OBJECTIVE

The aim of this study was to examine the effects of reflexology hand massage and stroking massage on pain and anxiety in patients in the immediate postoperative period after CABG.

METHODS

In this double-blind, randomized, placebo-controlled study, we compared the effects of a 20-minute hand-reflexology massage to placebo stroking massage on pain and anxiety in newly extubated patients in the intensive care unit who had undergone CABG surgery. Pain was measured by visual analog scale and anxiety by the State-Trait Anxiety Inventory before and at 5, 30, and 60 minutes post intervention.

RESULTS

A total of 48 patients were enrolled: 24 in the intervention group and 24 in the placebo. Mean pain scores were significantly reduced in the group who received reflexology compared with the placebo group (F = 36.569, P = .000). Mean anxiety scores were significantly reduced at 60 minutes for the reflexology group compared with the control group (P = .000).

CONCLUSIONS

We found that hand reflexology massage was effective in reducing pain and anxiety in patients during the immediate postoperative period after CABG.

The Effects of Preoperative Pain Education on Pain Severity in Cardiac Surgery Patients: A Pilot Randomized Control Trial

BACKGROUND

There is minimal research on the effect of individualized preoperative education on postoperative pain and postoperative pain medication intake.

AIM

The study objective was to assess the effect of individually tailored preoperative education on postoperative pain severity, number of pain breakthroughs, and use of pain medication in participants receiving the intervention compared to controls.

METHODS

A pilot study with 200 participants was conducted. The experimental group received an informational booklet and discussed their ideas surrounding pain and pain medication with the researcher. Controls received no intervention. Postoperative pain severity was measured by a Numerical Rating System (NRS), which was divided into mild (NRS 1-3), moderate (NRS 4-6), and severe (NRS 7-10).

RESULTS

In the participant cohort, 68.8% of participants were male, and the average age was 60.48±10.7. Average postoperative 48-hour cumulative pain scores were lower in those who received the intervention compared to controls; 50.0 (IQR 35.8-60.0) vs. 65 (IQR 51.0-73.0; p < .01) participants who received the intervention had less frequent pain breakthroughs when compared to controls (3.0 [IQR 2.0-5.0] vs. 6.0 [IQR 4.0-8.0; p < .01]). There was no significant difference in the amount of pain medication taken by either group.

CONCLUSIONS

Participants who receive individualized preoperative pain education are more likely to have decreased postoperative pain.

Society of Pain and Palliative Care Pharmacists White Paper on the Role of Opioid Stewardship Pharmacists

Opioid stewardship is one essential function of pain and palliative care pharmacists and a critical need in the United States. In recent years, this country has been plagued by two public health emergencies: an opioid crisis and the COVID-19 pandemic, which has exacerbated the opioid epidemic through its economic and psychosocial toll. To develop an opioid stewardship program, a systematic approach is needed. This will be detailed in part here by the Opioid Stewardship Taskforce of the Society of Pain and Palliative Care Pharmacists (SPPCP), focusing on the role of the pharmacist. Many pain and palliative care pharmacists have made significant contributions to the development and daily operation of such programs while also completing other competing clinical tasks, including direct patient care. To ensure dedicated time and attention to critical opioid stewardship efforts, SPPCP recommends and endorses opioid stewardship models employing a full time, opioid stewardship pharmacist in both the inpatient and outpatient setting. Early research suggests that opioid stewardship pharmacists are pivotal to improving opioid metrics and pain care outcomes. However, further research and development in this area of practice is needed and encouraged.

Transforming acute pain management in children: A concept analysis to develop a new model of nurse, child and parent partnership

OBJECTIVES

To identify the core components of acute pain management in children, re-conceptualise the process and update the existing model to inform nursing research and clinical practice.

BACKGROUND

Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient-centred approach and a conceptual model which includes the role of parents and partnership.

DESIGN

Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children.

METHODS

A scoping review of peer-reviewed literature from 1990 through 2020 was conducted using the terms "pain management," "pain control," "pain treatment," "multi modal," and "concept*". Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised. The PRISMA 2020 checklist was used.

RESULTS

A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision-making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process.

CONCLUSION

The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient-centred. The new collaborative model will promote shared decision-making for individualised pain assessments, interventions and evaluations.

RELEVANCE TO CLINICAL PRACTICE

Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain assessments, optimise treatment selections, advancing clinical practice, patient outcomes and nursing science. No Patient or Public Contributions were included in this paper as this was a concept analysis pulling from past works.

Physical compatibility and chemical stability of dezocine and ramosetron in 0.9% sodium chloride injection for patient-controlled analgesia administration

As an antiemetic, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist (ramosetron) is generally administered to prevent and treat postoperative nausea and vomiting induced by intravenous dezocine for patient-controlled analgesia. To date, the physicochemical stability of dezocine-ramosetron admixtures has not been assessed. The primary objective of this study was to evaluate the physicochemical stability of a combination of dezocine and ramosetron in 0.9% sodium chloride (normal saline [NS]) injections. Dezocine-ramosetron admixtures were prepared and stored in glass bottles and polyvinyl chloride (PVC) bags refrigerated at 4°C or stored at ambient temperatures (25°C) for up to 14 days. Initial concentrations were 5.0 mg/100 mL for dezocine and 0.3 mg/100 mL for ramosetron used as the diluents. Stability parameters (drug concentrations and pH values) were determined using high-performance liquid chromatography and pH measurements, respectively. Compatibility (cloudiness, discoloration, and precipitation) was assessed visually. After 14 days at 4 °C or 25 °C, the concentration losses of dezocine and ramosetron were both < 4%. Furthermore, there were no significant changes in color, turbidity, or pH values were observed in any of the batches. The results indicated that mixtures of dezocine and ramosetron in NS injections were continuously physically and chemically stable for 14 days in glass bottles or PVC bags stored at 4 °C or 25 °C.

Nurses' management of children's acute postoperative pain: A theory of bureaucratic caring deductive study

BACKGROUND

Few studies have examined the translation of nurses' knowledge of pain management into clinical practice or how nurses negotiated the bureaucracy of caring to treat patients' acute pain.

PURPOSE

This study describes factors that influence pediatric nurses' actions in caring for hospitalized children's acute post-surgical pain.

METHOD

Ray's Theory of Bureaucratic Caring provided the theoretical framework for this mixed methods study of ethnography and human factors engineering. Fourteen nurses were observed throughout their shifts (175.5 h) to elucidate humanistic and bureaucratic influences.

FINDINGS

Of 105 pain assessments, nurses intervened with pharmacologic (n = 45) and biobehavioral (n = 13) interventions for pediatric patients' post-surgical pain in less than 11 min; and 25 assessments revealed patients did not have pain. Pain was assessed and no intervention was provided to 4 patients who were asleep, 5 patients who refused, 2 patients who had no ordered analgesics and 10 patients who were assessed prior to peak effectiveness of their prior analgesic. Overall pain was well-controlled. Of the 28 themes identified, the interplay of 6 categorized to the social/cultural humanistic, 7 political, and 6 technologic/physiological bureaucratic dimensions most strongly influenced pain care.

DISCUSSION

To achieve optimal pain care outcomes, nurses' and parents' pain management knowledge was less influential for clinical practice translation than nurses' negotiation of other dimensions of bureaucratic caring.

Utility of unidimensional and functional pain assessment tools in adult postoperative patients: a systematic review

BACKGROUND

We aimed to appraise the evidence relating to the measurement properties of unidimensional tools to quantify pain after surgery. Furthermore, we wished to identify the tools used to assess interference of pain with functional recovery.

METHODS

Four electronic sources (MEDLINE, Embase, CINAHL, PsycINFO) were searched in August 2020. Two reviewers independently screened articles and assessed risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

RESULTS

Thirty-one studies with a total of 12 498 participants were included. Most of the studies failed to meet the methodological quality standards required by COSMIN. Studies of unidimensional assessment tools were underpinned by low-quality evidence for reliability (five studies), and responsiveness (seven studies). Convergent validity was the most studied property (13 studies) with moderate to high correlation ranging from 0.5 to 0.9 between unidimensional tools. Interpretability results were available only for the visual analogue scale (seven studies) and numerical rating scale (four studies). Studies on functional assessment tools were scarce; only one study included an 'Objective Pain Score,' a tool assessing pain interference with respiratory function, and it had low-quality for convergent validity.

CONCLUSIONS

This systematic review challenges the validity and reliability of unidimensional tools in adult patients after surgery. We found no evidence that any one unidimensional tool has superior measurement properties in assessing postoperative pain. In addition, because promoting function is a crucial perioperative goal, psychometric validation studies of functional pain assessment tools are needed to improve pain assessment and management.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42020213495.

Prescribing and Administering Opioid Doses Based Solely on Pain Intensity: Update of a Position Statement by the American Society for Pain Management NursingⓇ

Prescribing and administering opioid doses based solely on pain intensity is inappropriate and potentially unsafe for many reasons, including that pain intensity ratings are completely subjective, cannot be measured objectively, are dynamic as the experience of pain is dynamic, and may be describing a construct other than intensity (i.e. suffering). Many factors, in addition to pain intensity, influence opioid requirements and subsequent dosing. The American Society for Pain Management Nursing (ASPMN) holds the position that the practice of prescribing and administering doses of opioid analgesics based solely on a patient's pain intensity should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to negative patient outcomes.

Prescribing and Administering Opioid Doses Based Solely on Pain Intensity: Update of A Position Statement by the American Society for Pain Management Nursing

The foundation of safe and effective pain management is an individualized, comprehensive pain assessment that includes, but is not limited to, the intensity of pain if the patient is able to report it. An unforeseen consequence of the widespread use of pain intensity rating scales is the practice of prescribing specific doses of opioid analgesics based solely on specific pain intensity ratings. Many factors in addition to pain intensity influence opioid requirements. To date there is no research demonstrating that a specific opioid dose will relieve pain of a specific intensity in all patients or even in the same patient at different times. The official position of the American Society for Pain Management Nursing (ASPMN) maintains that the practice of prescribing doses of opioid analgesics based solely on pain intensity should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to untoward patient outcomes.

Multidimensional Self-report Assessment of Children's Acute Pain in an Inpatient Setting

OBJECTIVE

This study assessed the feasibility of administering a multidimensional, self-report pain assessment protocol to children in an inpatient, acute pain context, and sought insight into the interrelationships between sensory, affective, and evaluative pain dimensions.

METHODS

A total of 132 children (5 to 16 y) experiencing acute pain were recruited from acute pain ward rounds or the short-stay surgical unit. A multidimensional self-report assessment protocol was administered, assessing pain intensity, pain-related affect, bother, perceived unfairness, and pain expectations (for tomorrow and in 1 wk). Duration of protocol administration was assessed and ease of administration was rated. Pain-related behaviors were rated using the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale.

RESULTS

The duration of protocol administration was <2.5 minutes, on average, for all age groups. Median ease of protocol administration was 7/10 for 5- to 7-year-olds and 8/10 for older age groups. Pain-related bother was higher for 14- to 16-year-olds, relative to younger age groups, and significantly correlated with perceived unfairness (r=0.59, P<0.01), intensity (r=0.76, P<0.01), and affect (r=0.33, P<0.05). For younger age groups, bother was significantly positively correlated only with pain intensity (rs=0.59 to 0.79, Ps<0.01) and affect (rs=0.4 to 0.71, Ps <0.05). A stepwise multiple regression analysis found multidimensional self-reported information (especially pain intensity and perceived unfairness), accounted for significant additional amount of variance, beyond that explained by age, pain duration, and observed pain behavior.

DISCUSSION

Sensory, affective, and evaluative aspects of children's clinical, acute pain experience may be assessed using self-report tools, which provide unique and valuable information about their pain experience.

Systematic Review on Pain-Related Outcome Domains After Sternotomy: A First Step Toward the Development of a Core Outcome Set

OBJECTIVES

Pain after surgery has a major impact on acute and long-term recovery and quality of life, but its management is often insufficient. To enhance the quality of research and to allow for better comparability between studies, it is important to harmonize outcomes for assessing the efficacy and effectiveness of pain management interventions after surgery. As a first step in developing a core outcome set, this study aimed to systematically search for outcome domains assessed in research regarding acute pain management after sternotomy as an example of a typically painful surgical procedure.

METHODS

A systematic literature review was performed using MEDLINE, Embase, and CENTRAL. Eligibility criteria consisted of randomized controlled trials and observational trials targeting pain management after sternotomy in adults in the acute postoperative setting (≤2 weeks). After duplicate removal and title and abstract screening by 2 independent reviewers, study characteristics and outcome domains were identified, which were extracted from full texts and summarized qualitatively.

RESULTS

Of 1350 studies retrieved by database searching, 156 studies were included for full-text extraction. A total of 80 different outcome domains were identified: pain intensity, analgesic consumption, physiological function, and adverse events were the most frequent ones. Outcome domains were often not explicitly reported, and the combination of domains and assessment tools was heterogeneous. The choice of outcomes is commonly made within clinicians; patients' perspectives are not considered.

CONCLUSIONS

The wide variety of commonly applied outcome domains, the nonexplicit wording, and the heterogeneous combination of the domains indicating treatment benefit demonstrate the need for harmonization of outcomes assessing perioperative pain management after surgery.

Assessing outcome in postoperative pain trials: are we missing the point? A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty

ABSTRACT

The management of acute postoperative pain remains suboptimal. Systematic reviews and Cochrane analysis can assist with collating evidence about treatment efficacy, but the results are limited in part by heterogeneity of endpoints in clinical trials. In addition, the chosen endpoints may not be entirely clinically relevant. To investigate the endpoints assessed in perioperative pain trials, we performed a systematic literature review on outcome domains assessing effectiveness of acute pain interventions in trials after total knee arthroplasty. We followed the Cochrane recommendations for systematic reviews, searching PubMed, Cochrane, and Embase, resulting in the screening of 1590 potentially eligible studies. After final inclusion of 295 studies, we identified 11 outcome domains and 45 subdomains/descriptors with the domain "pain"/"pain intensity" most commonly assessed (98.3%), followed by "analgesic consumption" (88.8%) and "side effects" (75.3%). By contrast, "physical function" (53.5%), "satisfaction" (28.8%), and "psychological function" (11.9%) were given much less consideration. The combinations of outcome domains were inhomogeneous throughout the studies, regardless of the type of pain management investigated. In conclusion, we found that there was high variability in outcome domains and inhomogeneous combinations, as well as inconsistent subdomain descriptions and utilization in trials comparing for effectiveness of pain interventions after total knee arthroplasty. This points towards the need for harmonizing outcome domains, eg, by consenting on a core outcome set of domains which are relevant for both stakeholders and patients. Such a core outcome set should include at least 3 domains from 3 different health core areas such as pain intensity, physical function, and one psychological domain.

The Pain Nurse Practitioner and Pain Nurse's Role and Views on Opioid Management in Australia: A National Questionnaire Survey

BACKGROUND

The demand for access to Australian pain management services is growing. The dual crisis of opioid misuse and chronic pain, means pain nurses and nurse practitioners (NPs) have a unique opportunity to meet clinical demands and advance their scope of practice.

AIMS

To understand the role of pain nurses and pain NPs across Australia and explore their perceptions of current opioid management.

DESIGN

This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society.

METHODS

This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. Survey respondents were contacted via the eight nursing Pain Interest Groups in Australia.

RESULTS

Acute pain management (92.7%) and chronic pain management (80.5%) were the primary services provided, with pain specialty nurses providing nurse education (100.0%), patient support, clinician education, and policy development. Pain nurses believed there was an over prescription of opioid analgesics in Australia (97.6%), with NPs able to reduce opioid medication doses as part of opioid harm mitigation.

CONCLUSIONS

Pain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.

The music video therapy in postoperative analgesia in preschool children after cardiothoracic surgery

OBJECTIVES

To observe the effect of music video (MV) therapy on early postoperative pain in preschool children after cardiothoracic surgery.

METHODS

116 preschool children undergoing cardiothoracic surgery were randomly divided into the MV and control groups from June 2019 to March 2020. The related vital signs parameters, the Wong-Baker FACES pain rating scale, the FLACC scale, the number of postoperative PCA press and the cumulants of sufentanil use were recorded and analyzed.

RESULTS

There were no statistically significant differences in general characteristics and preintervention data between the two groups. However, there were significantly lower in the heart rate, mean arterial pressure, respiratory rate, the number of postoperative PCA press, and the dosage of sufentanil in the MV group than those in the control group after the intervention. The Wong-Baker FACES and FLACC scales in the MV group were significantly lower than those in the control group at the time point of immediately after the first intervention, 1 day, and 2 days after the intervention. The two pain scores showed a downward trend over time, and the corresponding scores in the MV group were better than those in the control group.

CONCLUSION

MV therapy can be an effective nonpharmaceutical intervention in the clinical to relieve children's postoperative pain after cardiothoracic surgery.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

Patient Experience with Postpartum Pain Management in the Face of the Opioid Crisis

INTRODUCTION

Professional societies have urged providers to reduce opioid use for pain management. Accordingly, the objective of this study was to assess patient experiences related to postpartum pain management in an effort to better understand potential paths to achieve such a reduction.

METHODS

This is a planned secondary analysis of a prospective observational study of opioid use following birth. In the primary study, women who received opioids as inpatients were queried about their pain management, including questions about pain experience, pain satisfaction, perceived areas for practice improvement, and the opportunity to leave additional comments. Participants who were prescribed opioids upon discharge completed postdischarge surveys with a similar opportunity for qualitative input. Data were analyzed using the constant comparative method to identify themes and subthemes.

RESULTS

Of the 493 women enrolled in the primary analysis, 125 provided qualitative data. Three overarching themes regarding pain management were identified: positive experiences (n = 22), negative experiences (n = 19), and beliefs and preferences on opioid use and pain management (n = 28). Women with positive experiences reported satisfaction with timely pain medication administration and appreciation of open dialogue with their care team. In contrast, several negative experiences centered on tardy administration of pain medications, resulting in increased pain. Patients also perceived judgment, accusation, and excessive lecturing by staff when requesting opioid medications. Finally, participants expressed the necessity for opioids for postpartum pain management, as well as their desires for limiting opioid use, improved options for multimodal pain management, and increased communication with providers about pain regimens.

DISCUSSION

Understanding women's perspectives and experiences regarding postpartum pain control is essential to improving care. Amid growing research on the role of maternity care providers in addressing the opioid crisis, women's voices are rarely solicited. These findings stress the importance of open and frequent dialogue between patients and providers and a need for multimodal pain management options.

A Paradigm Shift for Movement-based Pain Assessment in Older Adults: Practice, Policy and Regulatory Drivers

BACKGROUND

The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest.

OBJECTIVE

The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessment in older adults, as well as the practice, policy, and regulatory drivers that support this practice change.

Assessment of Pain and Associated Comorbidities: A Survey of Real Life Experiences Among Nurses in Italy

PURPOSE

Pain is a symptom that should be evaluated along with its comorbidities in order to plan an effective holistic treatment strategy involving specific pharmacological interventions, side effect management, psychological support, control of therapeutic effects over time, and dialogue with the patient and their relatives. In this holistic process of caring for patients with pain, nurses play a central role as they deal with suffering patients directly and continuously. The purpose of this study was to evaluate the types of pain identified by nurses in their daily clinical practice and the associated comorbidities (anamnestic history taking) by geographical region and to evaluate the pharmacological strategies used.

METHODS

A cross-sectional survey was performed among 696 registered nurses in Italy. Data were collected using an online questionnaire.

RESULTS

There was a significant difference between geographical regions in terms of reports of acute and chronic pain: acute pain was more frequently reported in the South (63.5%), while chronic pain was more frequent in the Central region (32.3%; p=0.0008). Additionally, chronic oncological pain was more frequent in the Northeast (29.6%), while chronic non-oncological pain was more frequently reported in the Central region (33.9%; p=0.0001). The underlying pain disorders reported were also different between geographical regions; rheumatic pain (21.8%) and neurological pain (18.6%) were more frequent in the Central region, while musculoskeletal pain was significantly more frequent in the South (43.4%; p=0.004). Anxiety, sleep disorders and somatization were found in acute pain (60.82%, 43.56% and 53.12%), while depression and mood disorders were more frequently detected in chronic pain condition (p<0.001).

CONCLUSION

Our study showed differences among Italian regions in pain assessment. Specific education on pain management nursing is essential for nurses. Promotion of optimal nursing care for people affected by pain is the main focus of pain management nursing. Nowadays, nurses should focus on personalized complex care and research in order to improve the patient's quality of life.

A Scoping Review of Nursing's Contribution to the Management of Patients with Pain and Opioid Misuse

BACKGROUND

Nursing brings a unique lens to care of patients with pain and opioid misuse.

AIMS

This scoping review describes nursing's contribution to the literature on the management of patients with pain and opioid misuse, generating evidence to guide clinical care.

DESIGN

The scoping review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guideline.

DATA SOURCES

Using combined key terms ("opioid misuse," "pain," "nursing") in systematic searches in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases, snowball technique, and personal knowledge resulted in 108 relevant articles, reports, and websites.

ANALYSIS METHOD

Summative approach to content analysis was used to quantify and describe nursing's contribution to the literature.

RESULTS

Contributions of nurses emerged in the areas of research, clinical practice, policy, and education. The highest number of publications addressed research (50%, 54 of 108), whereas the fewest number of publications involved education (7%, 8 of 108).

CONCLUSION

Results provide a picture of the breadth of expertise and crucial leadership that nurses contribute to influence management of patients with pain and opioid misuse.

IMPLICATIONS FOR NURSING

This scoping review indicates the importance of continued support from key stakeholders, including training and interprofessional collaboration opportunities supported by the National Institutes of Health, to sustain nursing's contribution to quality care of patients with pain and opioid misuse. Ultimately, all health care professionals must collaborate to conduct rigorous research and construct evidence-based guidelines to inform policy initiatives and education strategies to solve the complex co-occurring epidemics of pain and opioid misuse.

Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age

Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.

Comparison of preemptive paracetamol, paracetamol-diclofenac & paracetamol-tramadol combination on postoperative pain after elective abdominal surgery under general anesthesia, Ethiopia: a randomized control trial study, 2018

Background

In the practice of postoperative pain management, pain is still poorly managed in low resource setting where the practice of epidural and opioid free analgesia is impractical. There has been a recent trend of combining different drugs and concept of preemptive analgesia but the therapeutic superiority remains understudied for postoperative pain management. The aim of this study is to assess postoperative analgesic effect of preemptive Paracetamol, Paracetamol-diclofenac and Paracetamol-tramadol combination in patients undergoing laparotomy surgery.

Methods

Three-arm, randomized control trial study conducted on 63 patients undergone laparotomy surgery; group-P (paracetamol 1 g), group-PD (1 g + diclofenac 75 mg) and group-PT (paracetamol 1 g + tramadol 100 mg). The Numerical Rating Scale (NRS) pain rating system was used for this study. The primary endpoint of the study was total amount of analgesia consumption. Post-operative analgesic therapy [intravenous tramadol, 50 mg] were provided when patients complain of pain (request medication) or a numeric rating scale ≥4 was recorded. Secondary endpoint of the study were the time of first analgesic request and the intensity of the pain during 24 h post-op follow up period. Parametric data were analyzed using (ANOVA) and nonparametric data analyzed by Kuruska-Wallis H rank test. Chi-square test used for categorical variable. Statistical significance were sated at p value < 0.05 with a power of 80%.

Results

The mean total tramadol consumption was significant higher in paracetamol group 250 ± 79.06 mg compared to paracetamol-diclofenac (173.81 ± 87.49 mg p = 0. 008) and paracetamol-tramadol (154.76 ± 70.54 mg p = 0. 001) group. Time to first analgesic request was significantly shorter within paracetamol group (87.62 ± 20.95 min) compared to paracetamol-diclofenac (103.01 ± 23.53 min p = 0.029) and paracetamol-tramadol (144.05 ± 14.72 min p < 0.001) group. There was statistically significant difference at 4th, 6th and 8th hour showing lower median pain score in paracetamol-tramadol group compared to paracetamol group.

Conclusion

Preemptive combination of paracetamol-tramadol and paracetamol-diclofenac reduce total tramadol consumption and prolongs time to first analgesic request compared to paracetamol alone in patients undergoing laparotomy surgery.

Trial registration

The study was retrospectively registered on 07 July 2019 at Pan African Clinical Trial Registry with the identification number of PACTR201908890749145. It was accepted on 14 August 2019.

Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study

BACKGROUND

Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery.

AIM

The aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain.

METHOD

A randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication.

RESULTS

The findings of this study indicate that foot massage significantly (p < .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group.

CONCLUSION

Providing non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants' satisfaction.

Effect of Pain Management Electronic Order Sets on Opioid Use in Adult Rib Fracture Patients

BACKGROUND

Inpatient pain management order sets are an important and necessary tool for standardizing and enhancing pain management for patients with traumatic injury. The purpose of this study was to assess the impact of revised inpatient pain management electronic order sets on opioid usage for patients with significant chest wall trauma.

METHODS

A retrospective pre-post study was conducted for adult patients with 3 or more rib fractures admitted to the hospital at a Level 1 trauma center. Two periods were compared: 1 year prior to the order set changes and the period immediately after the revisions were implemented. Differences between medians were assessed using Kruskal-Wallis test by ranks, and differences between nominal variables were assessed with χ test.

RESULTS

Twenty-five patients were analyzed for each period. There was no significant change between periods in the total amount of opioid received per day. There was a significant reduction in intravenous (IV) opioid use on the general inpatient floor (61% vs. 24%, p = .01), as well as in the percentage of patients who received IV opioid within 24 hr of discharge (40% vs. 4%, p = .002).

CONCLUSION

Revised inpatient pain management order sets did not reduce overall opioid usage in a population of patients with 3 or more rib fractures. However, significant improvements were noted in decreased IV opioid usage on the general inpatient floors and within 24 hr of patient discharge from the hospital.

CE: Managing Pain in Critically Ill Adults: A Holistic Approach

Nurses caring for critically ill adults are challenged to balance patient comfort with the risk of complications associated with analgesic therapy. Evidence gathered since 2013, when the Society of Critical Care Medicine (SCCM) published the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit, known as the PAD guidelines, gave rise to the SCCM 2018 publication of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS guidelines. This article discusses how the PADIS guidelines go beyond the PAD guidelines, providing specific guidance related to risk factors for pain, the assessment and management of pain in critical illness, and the ways in which the experience of pain in critical illness is intertwined with that of agitation, delirium, immobility, and sleep disruption. Tables summarize the key points in the PADIS guidelines, clarify the distinctions between PADIS and PAD, and describe the implications for nurses.

Validation of the Greek Version of Comfort-B, FLACC, and BPS Scales in Critically Ill Children and Their Association with Clinical Severity

BACKGROUND

A variety of valid pediatric pain assessment tools are used in clinical practice globally; however, none have been validated for use in the Pediatric Intensive Care Unit (PICU) in Greece. Furthermore, the association between pain behavioral responses and clinical status is unclear.

AIMS

To assess the reliability and validity of the Greek version of FLACC, Comfort B, and BPS pain scales in critically ill children and to explore their association with clinical severity (Denver MOF, PMODS) and levels of sedation and analgesia.

METHODS

A methodological and descriptive correlational study was performed in a 6-bed PICU. A total of 60 observations in a sample of 30 children (mean age 4.1 years; 63.3% male) were obtained by 2 independent nurses during rest and painful procedures. At the same time, the bedside nurse assessed the child's pain intensity using the VASobs.

RESULTS

High internal consistency and strong interrater reliability were detected (Cronbach's alpha ≥ .85; ICC > .95, p < .001). The agreement between observers was satisfactory (0.71 ≤ Kappa ≤ 0.96, p < .001). Strong correlations were found among the scales (0.65 ≤ rho ≤0 .98, p < .05). Increased pain scores (≥moderate pain) were observed during painful procedures regardless the administration of analgesia. Statistically significant correlations were found between clinical severity and the FLACC and Comfort B scores (-0.577 ≤ rho ≤ -0.384, p < .05).

CONCLUSIONS

These pain tools were found to be suitable for this sample of children in Greece. Wider application of these tools in Greek PICUs and further research regarding their association with the clinical severity and the pain responses is required for the improvement of pain management in critically ill children.

Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience

Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.

Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer

Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child's pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children's self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.

Nurses’ certainty and pain outcomes of nursing home residents with dementia: the mediating effect of pain assessment

Aim: This study aims to examine the associations of pain assessment scope, nurses’ certainty, patient outcomes, and cognitive and verbal characteristics of nursing home (NH) residents. Methods: This study used a descriptive correlational design and a convenience sample of 78 NH residents with dementia. Results: There are significant associations between the severity of dementia and the ability to self report symptoms in NH residents and nurses’ certainty of pain. Also, pain assessment scope does not mediate the relationship between nurses’ certainty and patient outcomes. Conclusion: Pain assessment in NH residents with dementia is very challenging for nurses due to multiple complex factors. Improved understanding of pain assessment in those residents and how it relates to certainty of pain and patient outcomes are crucial.

The Effectiveness of an Evidence-Based Pain Management Program on Pain Intensity and Chest Rehabilitation Improvement Among Chest Trauma Patients in a Thai Hospital

BACKGROUND

Pain after thoracic injury has further profound impacts on patients resulting in increased length of hospital stay and hospital care cost, and decreased quality of life. Utilization of the cutting-edge evidence on pain management that fits with the individual care context is therefore important.

AIM

To examine the effects of an evidenced-based pain management program on the worst pain intensity and lung vital capacity among acutely ill hospitalized chest trauma patients.

DESIGN

A two-group repeated measures design.

SETTINGS

trauma unit, a university hospital in southern Thailand.

PARTICIPANTS/SUBJECTS

42 chest trauma patients.

METHODS

The study population included 42 chest trauma patients admitted to the trauma unit. Twenty-one eligible chest trauma patients were consecutively assigned into intervention and control groups. The impacts of the intervention on the level of the worst pain intensity and lung vital capacity were measured before implementation of the program and throughout the first 5 days of admission.

RESULTS

The study found a significant reduction in the worst pain intensity and an increase in the lung vital capacity among chest trauma patients in the intervention group compared with the control group (p < .05).

CONCLUSIONS

Use of a pain management program can be an effective, inexpensive, and low-risk intervention for the improvement of pain management and chest rehabilitation among chest trauma patients.

The Complexities of Nurses' Pain Assessment in Hospitalized Preverbal Children

BACKGROUND

Preverbal children are at increased risk for underassessment of pain. Pain is a social transaction involving the child in pain and the nurse assessor. However, our understanding of the nurse's part in this transaction is limited.

AIMS

The aim of this study was to explore nurses' assessment of pain in hospitalized preverbal children based on self-selected clinical examples.

DESIGN

Qualitative, descriptive design.

SETTINGS

Five different hospital units in Canada and Norway. All units had an observational pain scale for preverbal children available for use.

PARTICIPANTS/SUBJECTS

Nurses (N = 22) with ≥1 year experience caring for preverbal children.

METHODS

Individual, semistructured interviews. Data were analyzed using inductive thematic analysis.

RESULTS

Nurses' assessment of pain in hospitalized preverbal children emerged as a nonlinear complex process incorporating different actions and reflections in response to the child's situation and expression of distress. Information from parents was routinely included in the assessment, although further parental involvement varied considerably. Although each assessment was personalized to the individual child, the nurse used previous experiences to interpret observations of and information from the child and the parents. Few nurses described using structured pain scales, but when used, these scales were included as only one aspect of their overall assessment.

CONCLUSIONS

Nurses preferred pain assessment based on clinical judgment and tailored to the individual child. Implementation strategies that aim to integrate structured pain scales with clinical judgment to assess pain may be more likely to succed. Further examination of this approach is warranted.

Pilot Testing the Clinically Aligned Pain Assessment (CAPA) Measure

BACKGROUND

Pain is one of the most common symptoms experienced by patients in acute care hospitals and acutely ill patients experience both acute and chronic pain. Unrelieved pain can have a profound negative impact on individuals' functional status, well-being, quality of life, and satisfaction with care. For providers, managing pain can be challenging. While the numeric rating scale is widely accepted and used, it measures only pain intensity. CAPA® pain assessment offers an alternative approach in which providers have a conversation with patients about pain and how it impacts five key areas.

AIMS

The purpose of this pilot project was to evaluate provider and patient satisfaction with the CAPA® measure as compared to a numeric rating scale when evaluating patients' experience with pain.

DESIGN

A mixed methods qualitative design was employed.

SETTING

This study was conducted at a 247-bed community teaching hospital in Providence, RI.

PARTICIPANTS

The target sample included patients admitted to the study units and providers who delivered care to patients on the study units and used the numeric rating scale and the CAPA® method of assessment.

METHODS

In focus groups, nurses and physicians were asked about satisfaction with evaluating patients' pain with the numeric rating scale as compared to CAPA®. During a one-to-one interview, patients were asked to describe their impressions of the two assessment measures.

RESULTS

Nurses, physicians, and patients were satisfied that CAPA® effectively evaluated pain and provided more information about pain than the numeric rating scale.

CONCLUSIONS

CAPA® is recommended as a supporting assessment to evaluate patients' pain experience in acute care.

Managing Opioid Use in Orthopaedic Patients Through Harm Reduction Strategies

Opioids are commonly prescribed in orthopaedics for acute or chronic pain for a variety of conditions, including injury, trauma, degenerative processes, and postsurgical. Patients who are taking opioids because of a substance use disorder (SUD) are also seen in orthopaedics. Patients who are prescribed opioids are at risk of developing an opioid use disorder (OUD). Ten percent of Americans will develop an SUD, which is considered a chronic medical condition that develops due to an imbalance in brain chemistry. In studies, orthopaedic surgeons have a high rate of prescribing opioids, but this rate is decreasing along with national average due to public and provider awareness of the opioid epidemic and professional recommendations. Despite the evidence of a neurobiological cause for SUDs, stigma toward patients with SUDs and a knowledge deficit are common among healthcare professionals, including orthopaedic nurses. A harm reduction approach when working with orthopaedic patients taking opioids either prescribed or used because of an OUD can be applied to reduce the problematic effects of opioids. Harm reduction strategies are supportive to the patient and include education and prevention, adopting evidence-based treatment and communication strategies, and the use of naloxone to prevent opioid overdose.

Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

BACKGROUND

Current research on opioid use within orthopedic surgery has focused on efforts to identify patients at risk for chronic opioid use. Studies addressing prevention of opioid misuse related to orthopedic care are lacking. Evidence-based interventions to reduce the reliance on opioids for post-operative pain relief will be a key component of any comprehensive institutional opioid policy.

QUESTIONS/PURPOSES

The purpose of this systematic review was to evaluate institutional strategies that reduce opioid administration or consumption after orthopedic surgery.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for English-language articles that analyzed interventions by physicians, nurses, pharmacists, physical therapists, or other hospital staff to reduce post-operative opioid use or narcotic prescription amounts after surgery. Studies that contained objective outcome measures (i.e., no expert opinion articles) were selected. Investigations on the effect of pharmacologic adjuvants, cryotherapy, or regional nerve blockades on opioid use were excluded.

RESULTS

The initial search yielded 6598 titles, of which 13 full-text articles were ultimately selected for inclusion in this systematic review. The review identified two major categories of interventions-patient-focused and provider-focused (e.g., physicians, nurses, physical therapists, pharmacists). Formal patient education programs were most effective in reducing opioid use. On the provider side, prescribing guidelines appear to decrease the overall number of pills prescribed, often without changes in patient satisfaction or requests for refills.

CONCLUSIONS

Researchers are just beginning to establish the most effective ways for institutions to reduce opioid use and promote responsible post-operative prescribing. Institutional prescribing guidelines, standardized bedside pain-management programs, and formal patient education curriculums are all evidence-based interventions that can achieve these goals. The available research also supports an interprofessional approach in any institutional opioid-reduction strategy.

Treating Chronic Nonmalignant Pain: Evidence and Faith-Based Approaches

A significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.

Compatibility and stability of dezocine and tropisetron in 0.9% sodium chloride injection for patient-controlled analgesia administration

Tropisetron is an adjuvant for dezocine used in intravenous patient-controlled analgesia (PCA) and has been reported to provide superior pain control. It is efficacious in reducing the institutional incidence of postoperative nausea and vomiting (PONV), which decreases resource utilization and cost. However, no scientific evidence has been reported in the literature demonstrating analytical confirmation of the compatibility and stability of the combination of dezocine and tropisetron. Thus, the present study aimed to investigate the stability of dezocine with tropisetron in 0.9% sodium chloride injection form for PCA administration.Commercial solutions of dezocine and tropisetron were combined and examined for compatibility and stability when diluted with 0.9% sodium chloride injection in polyolefin bags and glass bottles stored at 4°C or 25°C for up to 14 days. The initial concentrations were 40 mg/100 mL dezocine and 5 mg/100 mL tropisetron. For all samples, the compatibility parameters (including precipitation, cloudiness, discoloration, and pH values) were evaluated. Chemical stability was also determined using high-performance liquid chromatographic (HPLC) analysis.After a 14-day period of storage at 4°C or 25°C, the initial concentrations of dezocine and tropisetron were maintained at at least 98%. All of the mixtures remained clear and colorless throughout the observation period, and no color change or precipitation was observed.These results indicated that admixtures of 40 mg/100 mL dezocine and 5 mg/100 mL tropisetron in 0.9% sodium chloride injection were stable for at least 14 days when stored in polyolefin bags or glass bottles at 4°C or 25°C and protected from light.

Assessing the Impact of the Position Paper "Prescribing and Administering Opioid Doses Based Solely on Pain Intensity"

BACKGROUND

A task force of members of the American Society for Pain Management Nursing (ASPMN) authored a position paper "Prescribing and Administering Opioid Doses Based Solely on Pain Intensity." Some of the authors of this ASPMN position paper presented a concurrent session at the September 2016 ASPMN National Conference discussing the content of the position paper. As a follow-up, the authors designed a research study to identify the impact of the position statement in facilitating change in institutional practice of dosing analgesics based solely on pain intensity.

AIMS

Our aim was to ascertain the effect of the American Society for Pain Management Nursing ASPMN position paper "Prescribing and Administering Opioid Doses Based Solely on Pain Intensity" (2016) on changes in institutional practices.

DESIGN

The study used an online anonymous questionnaire that included open-ended questions.

SETTINGS

An anonymous electronic questionnaire was used to assess the impact across the United States.

PARTICIPANTS/SUBJECTS

Participants were members of the American Society for Pain Management Nursing.

METHODS

An eight-question anonymous questionnaire created through Survey Monkey was sent to members of the American Society for Pain Management Nursing via an e-mail listserv and the monthly e-newsletter.

RESULTS

Of the 142 members who consented to participate in the study, 120 members answered one or more questions. Those who responded to the question about changes in practice, only 13 (11.1%) reported that the position paper had influenced a change in practice at their institution. The majority, 89 (75%), reported that practice had not changed in their institution.

CONCLUSIONS

Among those clinicians who participated in this study, the position paper "Prescribing and Administering Opioid Doses Based Solely on Pain Intensity" reportedly had minimal impact on changing institutional practices.

Assessing and Managing Acute Pain: A Call to Action

: Acute pain, which is usually sudden in onset and time limited, serves a biological protective function, warning the body of impending danger. However, while acute pain often resolves over time with normal healing, unrelieved acute pain can disrupt activities of daily living and transition to chronic pain. This article describes the effects of unrelieved acute pain on patients and clinical outcomes. The authors call on nurses to assess and manage acute pain in accordance with evidence-based guidelines, expert consensus reports, and position statements from professional nursing organizations in order to minimize the likelihood of its becoming chronic.