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

Pain Predictors in Patients in the Postanesthesia Care Unit

PURPOSE

To analyze the effects of pain-predicting factors on patients in the postanesthesia care unit (PACU).

DESIGN

This is an observational and prospective study.

METHODS

This study was conducted at a University Hospital in the state of Minas Gerais (Brazil). To collect data on demographic, clinical, and surgical factors, a collection instrument was devised. The verbal numerical scale was employed to measure pain levels before and after surgery in the PACU. A path analysis was used to assess a predictive model.

FINDINGS

A total of 226 patients were included in this study. The incidence of pain in the PACU was 31.9%. A model with demographic, clinical, and surgical variables was tested. The final model, after including modification indices, obtained results that indicated an acceptable data fit (comparative fit index = 0.996; root mean square error of approximation = 0.08). Age (being young), sex (being a woman), oncological diagnosis as an indication for the surgical procedure, type of surgery (surgery of the digestive system), duration of surgery (longer surgeries), and high intraoperative doses of opioids were predictive variables for pain in the PACU.

CONCLUSIONS

This study's findings provide support for pain management in the PACU. Furthermore, the results of this research can be used to anticipate the occurrence of acute postoperative pain and personalized perioperative analgesia needs.

The Contribution of Cancer-Specific Psychosocial Factors to the Pain Experience in Cancer Survivors

Palliative care teams are increasingly called up to manage chronic pain in cancer survivors. Chronic pain is common in cancer survivors and is heavily influenced by biopsychosocial factors. This study aimed to determine the relative contribution of unique cancer-specific psychosocial factors, pain catastrophizing, and multisite pain to the pain experience in 41 cancer survivors who completed curative cancer treatment. To test the research hypotheses, a series of nested linear regression models were used with likelihood ratio testing to test the individual and collective contribution of cancer-specific psychosocial factors (fear of cancer recurrence, cancer distress, cancer-related trauma), pain catastrophizing, and the number of pain sites on the pain experience. The results indicate pain catastrophizing and multisite pain explained a significant degree of variance in pain interference scores ( P < .001) and pain severity ( P = .005). Cancer-specific psychosocial factors did not significantly predict variability in pain interference ( P = .313) or pain severity ( P = .668) over and above pain catastrophizing and the number of sites of pain. In summary, pain catastrophizing and multisite pain contribute to the chronic cancer-related pain experienced by cancer survivors. Palliative care nurses are well positioned to improve chronic pain among cancer survivors by assessing and treating pain catastrophizing and multisite pain.

"It's a proactive intervention instead of a reactive one": measuring facilitators and barriers regarding readiness to implement a treatment program for infants with neonatal opioid withdrawal syndrome

BACKGROUND

Managing Abstinence in Newborns (MAiN) is an evidence-based, cost-saving approach to caring for infants at risk of developing neonatal opioid withdrawal syndrome (NOWS). MAiN provides medication management in combination with education and is being implemented in hospitals across South Carolina (SC). This expansion of MAiN throughout the state includes educational training for providers on managing NOWS symptomology and evaluation support for data collection and analysis. This evaluation assessed the readiness of hospitals to implement MAiN by identifying potential barriers and facilitators to early program adoption.

METHODS

We used the Consolidated Framework for Implementation Framework (CFIR) to guide the evaluation. As part of the ongoing evaluation of MAiN implementation, brief, structured interviews were conducted with healthcare providers (n = 82) at seven hospitals between 2019 and 2022 to learn more about perceived barriers and facilitators to implementation readiness. Two coders independently reviewed all transcripts and used deductive thematic analysis to code qualitative data using Atlas.ti Web using the established CFIR codebook.

RESULTS

We identified barriers and facilitators to implementing MAiN in all five CFIR domains. Providers identified MAiN as an evidence-based, patient-centered model with the flexibility to adapt to patients' complex needs. Specific champions, external support, alignment with providers' personal motivation, and an adaptable implementation climate were identified as facilitators for implementation readiness. Barriers included a lack of consistent communication among hospital providers, minimal community resources to support patients and families after discharge, and a lack of provider buy-in early in implementation.

CONCLUSIONS

Key barriers and facilitators of MAiN implementation readiness were identified at seven participating hospitals throughout SC. Communication, staff and hospital culture and climate, and internal and external resource were all reported as essential to implementation. These findings could inform the MAiN program expansion in hospitals across SC.

A historical review of pain disparities research: Advancing toward health equity and empowerment

BACKGROUND AND PURPOSE

This theory-guided review draws on 30 years of published data to examine and interrogate the current and future state of pain disparities research.

METHODS

Using the Hierarchy of Health Disparity Research framework, we synthesize and present an overview of "three generations" of pain disparities scholarship, while proposing directions for adopting a "fourth generation" that redefines, explains, and theorizes future pain disparities research in a diverse society.

DISCUSSION

Prior research has focused on describing the scope of disparities, and throughout the historical context of human existence, racialized groups have been subjected to inadequate pain care. It is imperative that research not only illuminates existing problems but also provides solutions that can be implemented and sustained across varying social milieus.

CONCLUSION

We must invest in new theoretical models that expand on current perspectives and ideals that position all individuals at the forefront of justice and equity in their health.

Exercise interventions for older people with cognitive frailty-a scoping review

Background

As the global population ages, the issue of frailty in older people is gaining international attention. As one of the major subtypes of frailty, cognitive frailty is a heterogeneous clinical manifestation characterised by the co-existence of physical decline and cognitive impairment. The occurrence of cognitive frailty increases the risk of adverse health outcomes in older people, affecting their daily functioning and quality of life. However, cognitive frailty is a reversible state, and many interventions have been explored, with exercise interventions playing an important role in the non-pharmacological management of cognitive frailty. This study describes and summarises current exercise interventions for older people with cognitive frailty (including parameters such as mode, frequency and duration of exercise) and identifies the limitations of existing studies to inform future exercise interventions for older people with cognitive frailty.

Methods

Using a scoping review approach, Chinese and English literature published in PubMed, Web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Database, China Biomedical Literature Database (SinoMed) and Vipshop from April 2013, when the definition of cognitive frailty first appeared, to August 2021 was searched to select studies related to exercise interventions for this group, extract information from the included literature, and summarise and report the findings.

Results

Nine RCT trial studies and one quasi-experiment study were included, for a total of 10 articles. The exercise modalities involved walking, brisk walking, Otago exercise, resistance exercise, balance training, flexibility training and Baduanjin, etc.; the intensity of exercise was based on individualised guidance and graded exercise intensity; the frequency of exercise was mostly 3–4 times/week; the duration of exercise was mostly 30–60 min/time; compared to the control group, the included studies showed statistically significant improvements in cognitive function, frailty status, and depression with the exercise intervention.

Conclusion

There is a paucity of evidence on exercise interventions for older people with cognitive frailty. The evidence provided in this study suggests that exercise interventions may be beneficial for older people with cognitive frailty. However, the existing studies suffer from small sample sizes, short intervention periods, inadequate monitoring of the entire exercise process, and non-uniformity in the assessment of exercise effects. More randomized controlled trials should be conducted in the future to explore the most effective, low-cost and simple interventions to meet the needs of the older people with cognitive frailty.

Tuina combined with diet and exercise for simple obesity: A protocol for systematic review

BACKGROUND

The incidence of simple obesity is increasing annually, with the number of obese people in all age groups increasing significantly. Obesity has become an important public health concern. Simple obesity affects not only appearance but also health. Obesity has an increasing impact on individuals, families, and society. Therefore, the treatment of obesity is becoming increasingly important. Prior studies have shown that Tuina combined with diet and exercise is capable of producing improvements in body weight and fasted health markers. In recent years, there are many clinical studies on the intervention of simple obesity by Tuina combined with diet and exercise, however, no study systematically evaluated the clinical efficacy. The purpose of this study is to evaluate its effects of Tuina combined with diet and exercise on people with simple obesity.

METHODS

We will search the following electronic databases: PubMed, EMBASE, MEDLINE, Web of science, Cochrane Library, WanFang Data, CBM, CNKI, and VIP from the inception of the coverage of these databases to December 2021. Randomized controlled clinical trials related to Tuina combined with diet and exercise intervention on simple obesity will be included. Cochrane's collaboration tool will be used to assess the quality of the studies. RevMan 5.3 software will be used for the data analysis.

RESULTS

This study will provide a standardized evaluation for the efficacy of Tuina combined with diet and exercise for simple obesity.

CONCLUSION

The conclusion of this study will provide evidence for the safety and effectiveness of Tuina combined with diet and exercise on weight loss.

ETHICS AND DISSEMINATION

Ethical approval is not required for systematic review and meta- analysis. The results of this review will be disseminated in a peer-review journal.

PROSPERO REGISTRATION NUMBER

INPLASY202210079.

The effect of music interventions on chronic pain experienced by older adults: A systematic review

PURPOSE

To synthesize results from multiple studies to determine the effects of music interventions on chronic pain in older adults.

DESIGN

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to identify and select studies.

METHODS

Relevant studies were identified from nine electronic databases. The Joanna Briggs Institute (JBI) critical appraisal checklists were employed to assess methodological quality. All authors performed screening, data extraction, and synthesis. Inclusion criteria were clinical trials investigating music for chronic pain in older adults aged 65 and older.

FINDINGS

Eight studies involving 524 older adults were included, comprising five randomized controlled trials and three quasi-experimental studies. Music interventions consisted of live music, recorded music, and active music, with a variety of music styles and genres. Despite the small and short-term effects, five studies presented significantly positive outcomes for reducing chronic pain and its common comorbidities in older adults following music interventions. Three studies reported decreased trends in pain scores although they did not reach statistical significance.

CONCLUSIONS

Music has potential to be an effective adjuvant for managing chronic pain in older adults.

CLINICAL RELEVANCE

Nurses can incorporate music into the care of older adults with chronic pain.