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Olsen U, Sellevold VB, Gay CL, Aamodt A, Lerdal A, Hagen M, Dihle A, Lindberg MF. Factors associated with pain and functional impairment five years after total knee arthroplasty: a prospective observational study. BMC Musculoskelet Disord 2024; 25:22. [PMID: 38167008 PMCID: PMC10759478 DOI: 10.1186/s12891-023-07125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Few studies have evaluated the associations between preoperative factors and pain and physical function outcomes after total knee arthroplasty (TKA) from a mid-term perspective. Identification of such factors is important for optimizing outcomes following surgery. Thus, we examined the associations between selected preoperative factors and moderate to severe pain and pain-related functional impairment as measured using the Brief Pain Inventory (BPI), five years after TKA in patients with knee osteoarthritis. METHODS In this prospective observational study, all patients scheduled for primary unilateral TKA for osteoarthritis were consecutively recruited. Preoperative factors identified from previous meta-analyses were included to assess their associations with pain severity and pain-related functional impairment five years after TKA. Pain severity was the primary outcome, while pain-related functional impairment was the secondary outcome. The BPI was used to evaluate outcomes five years post-TKA. Statistically significant factors from univariate regressions were entered into a multiple logistic regression model to identify those with the strongest associations with pain severity or pain-related functional impairment five years after TKA. RESULTS A total of 136 patients were included, with a mean age of 67.7 years (SD 9.2) and a majority being female (68%). More severe preoperative pain (OR = 1.34, 95% CI [1.03 to 1.74]), more painful sites (OR = 1.28., 95% CI [1.01 to 1.63]), and more severe anxiety symptoms (OR = 1.14., 95% CI [1.01 to 1.28]) were associated with increased likelihood of moderate to severe pain five years after TKA surgery, while more severe osteoarthritis (OR = 0.13, 95% CI [0.03 to 0.61]) was associated with reduced likelihood of moderate to severe pain five years after TKA. More severe anxiety symptoms (OR = 1.25, 95% CI [1.08 to 1.46]) were also associated with increased likelihood of moderate to severe pain-related functional impairment five years after surgery, while male sex (OR = 0.23, 95% CI [0.05 to 0.98]) was associated with reduced likelihood of pain-related functional impairment five years after surgery. CONCLUSION The identified preoperative factors should be included in larger prognostic studies evaluating the associations between preoperative factors and mid-term pain severity and physical function outcomes after TKA surgery.
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Affiliation(s)
- Unni Olsen
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, 0440, Norway.
| | - Vibeke Bull Sellevold
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, USA
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, 0440, Norway
| | - Anners Lerdal
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Milada Hagen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Alfhild Dihle
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Maren Falch Lindberg
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, 0440, Norway
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Liu Y, Xiao S, Yang H, Lv X, Hou A, Ma Y, Jiang Y, Duan C, Mi W. Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100822. [PMID: 37927993 PMCID: PMC10625022 DOI: 10.1016/j.lanwpc.2023.100822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 11/07/2023]
Abstract
Background Postoperative pain poses a significant challenge to the healthcare system and patient satisfaction and is associated with chronic pain and long-term narcotic use. However, systemic assessment of the quality of postoperative pain management in China remains unavailable. Methods In this cross-sectional study, we analyzed data collected from a nationwide registry, China Acute Postoperative Pain Study (CAPOPS), between September 2019 and August 2021. Patients aged 18 years or above were required to complete a self-reported pain outcome questionnaire on the first postoperative day (POD1). Perioperative pain management and pain-related outcomes, including the severity of pain, adverse events caused by pain or pain management, and perception of care and satisfaction with pain management were analyzed. Findings A total of 26,193 adult patients were enrolled. There were 48.7% of patients who had moderate-to-severe pain on the first day after surgery, and pain severity was associated with poor recovery and patient satisfaction. The systemic opioid use was 68% on the first day after surgery, and 89% of them were used with intravenous patient-controlled analgesia, while the rate of postoperative nerve blocks was low. Interpretation Currently, almost half of patients still suffer from moderate-to-severe pain after surgery in China. The relatively high rate of systemic opioid use and low rate of nerve blocks used after surgery suggests that more effort is needed to improve the management of acute postoperative pain in China. Funding National Key Research and Development Program of China (No. 2018YFC2001905).
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Affiliation(s)
- Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
| | - Saisong Xiao
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
- Department of Anesthesia, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Huikai Yang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xuecai Lv
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Aisheng Hou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yandong Jiang
- Department of Anesthesiology, McGovern Medical School, University of Texas, Houston Health Science Center, Houston, TX, 77030, USA
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
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Bakshi SG, Kadam S, Shylasree TS. Predicting postoperative pain by using preoperative pain threshold in response to electrical stimulus in women undergoing gynaecological cancer surgery - Single-arm, prospective, observational study. Indian J Anaesth 2023; 67:497-502. [PMID: 37476433 PMCID: PMC10355356 DOI: 10.4103/ija.ija_503_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 07/22/2023] Open
Abstract
Background and Aims Individual variability leading to different pain experiences makes pain prediction challenging. This study aimed to evaluate whether preoperative electrical pain threshold testing is predictive of postoperative pain. Methods Following ethics committee approval and registration of the trial, 40 consenting patients undergoing open laparotomy (interval debulking surgery) for ovarian cancer were included in the study. Electrical stimulus (maximum of 256 μA) was used preoperatively to determine the current perception threshold (CPT) and pain equivalent current (PEC). A numerical rating scale (NRS; 0-10, with 0 indicating no pain and 10 indicating severe pain) was used to assess pain. All patients received intravenous paracetamol in accordance to body weight, diclofenac (1 mg/kg, maximum 50 mg), and tramadol (1 mg/kg, maximum 50 mg) eight hourly for 24 hours. The preoperative PEC was compared with worst pain score (PS) at movement at the end of 24 hours. PEC was also compared with average PS at rest, at movement, and with opioid requirement (24 hours). Results The median values of CPT and PEC were 12.51 (45 [10.1-14.6]) μA and 94.75 (174 [48.8-94.7]) μA, respectively. A moderate correlation was observed between PEC and worst PS (P = 0.01, r = -0.402), with patients having PEC less than 60 μA being associated with moderate-to-severe PS. There was no correlation between PEC and average PS at rest (P = 0.16, r = 0.225), at movement (P = 0.46, r = 0.119), and the postoperative opioid consumption in the first 24 hours (P = 0.50, r = -0.110). Conclusion There is a moderate association between preoperative pain threshold in response to electrical stimulus and worst PS in the postoperative period following interval debulking surgery for ovarian cancer.
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Affiliation(s)
- Sumitra G. Bakshi
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sonal Kadam
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - T. S. Shylasree
- Department of Gynaecolgy Onco- Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Stessel B, Lambrechts M, Evers S, Vanderstappen C, Callebaut I, Ory JP, Herbots J, Dreesen I, Vaninbroukx M, Van de Velde M. Additive or synergistic analgesic effect of metamizole on standard pain treatment at home after arthroscopic shoulder surgery: A randomised controlled superiority trial. Eur J Anaesthesiol 2023; 40:171-178. [PMID: 36632758 PMCID: PMC9894134 DOI: 10.1097/eja.0000000000001792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is growing evidence that the analgesic effect of metamizole is mediated at least partly by central mechanisms, including the endocannabinoid/endovanilloid system. Consequently, metamizole may have additive or even synergistic analgesic effects with paracetamol and nonsteroidal anti-inflammatory drugs (NSAID). OBJECTIVE This study aimed to assess if triple therapy with metamizole, ibuprofen and paracetamol (MIP) is superior to double therapy with ibuprofen and paracetamol (i.p.) in treating pain at home after ambulatory arthroscopic shoulder surgery. DESIGN/SETTING/PATIENTS/INTERVENTION In this double-blind, controlled, high-volume single centre, superiority trial, 110 patients undergoing elective ambulatory arthroscopic shoulder surgery were randomised to receive either MIP ( n = 55) or i.p. ( n = 55) orally for 4 days between December 2019 and November 2021. Pain intensity at movement and rest, using a numeric rating scale (NRS), perceived pain relief, use of rescue medication and adverse effects of study medication were recorded at the post-anaesthesia care unit (PACU) and on postoperative day (POD) 1 to 4 and 7. Quality of Recovery (QoR) and satisfaction with study medication were measured at POD 7 with telephone follow-up. MAIN OUTCOME MEASURE The primary outcome measure was postoperative pain intensity on movement measured by an 11-point NRS (where 0 = no pain and 10 = worst pain imaginable) on POD 1. RESULTS For the primary outcome, superiority of MIP in reducing postoperative pain at movement on POD 1 was not confirmed: mean difference NRS [95% confidence interval (CI), -0.08 (-1.00 to 0.84)]. For pain on movement and at rest, no significant differences were found between groups in the PACU nor on POD 1 to 4 or day 7. Nausea was reported significantly more frequently in the metamizole group (22.6 vs. 58.5; P < 0.001). Other adverse effects of study medication, rescue opioid consumption, perceived pain relief, QoR at POD 7, and overall patient satisfaction were similar in both groups. CONCLUSION Clinically, triple oral treatment with metamizole, paracetamol and ibuprofen is not superior to oral paracetamol and ibuprofen in multimodal pain treatment at home after ambulatory arthroscopic shoulder surgery. TRIAL REGISTRATION European Union Clinical Trials Register 2019-002801-23 and Clinicaltrials.gov NCT04082728.
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Affiliation(s)
- Björn Stessel
- From the Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt (BS, ML, SE, CV, IC, J-PO, JH), Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Diepenbeek (BS, IC), Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven (ML, MVdV), Department of Orthopaedic Surgery, Jessa Hospital, Hasselt (CV, MV) and Department of Pharmacy, Jessa Hospital, Hasselt, Belgium (ID)
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Terradas-Monllor M, Ochandorena-Acha M, Beltran-Alacreu H, Garcia Oltra E, Collado Saenz F, Hernandez Hermoso J. A feasibility study of home-based preoperative multimodal physiotherapy for patients scheduled for a total knee arthroplasty who catastrophize about their pain. Physiother Theory Pract 2022:1-20. [DOI: 10.1080/09593985.2022.2044423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marc Terradas-Monllor
- Faculty of Health Sciences and Welfare, University of Vic - Central University of Catalonia, Barcelona, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3o). Faculty of Health Sciences and Welfare. Center for Health and Social Care Research (CESS), University of Vic – Central University of Catalonia (Uvic-ucc), Barcelona, Spain
- Pain Medicine Section, Anaesthesiology Dept, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mirari Ochandorena-Acha
- Faculty of Health Sciences and Welfare, University of Vic - Central University of Catalonia, Barcelona, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3o). Faculty of Health Sciences and Welfare. Center for Health and Social Care Research (CESS), University of Vic – Central University of Catalonia (Uvic-ucc), Barcelona, Spain
| | - Hector Beltran-Alacreu
- Toledo Physiotherapy Research Group (Gifto), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Ester Garcia Oltra
- Orthopedic Surgery Department, Germans Trias I Pujol University Hospital, Badalona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Collado Saenz
- Orthopedic Surgery Department, Germans Trias I Pujol University Hospital, Badalona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Hernandez Hermoso
- Orthopedic Surgery Department, Germans Trias I Pujol University Hospital, Badalona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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McEvoy MD, Raymond BL, Krige A. Opioid-Sparing Perioperative Analgesia Within Enhanced Recovery Programs. Anesthesiol Clin 2022; 40:35-58. [PMID: 35236582 DOI: 10.1016/j.anclin.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Opioid-based analgesia in the perioperative period can provide excellent pain control, but this approach exposes the patient to avoidable side effects and possible harm. Optimal analgesia, an approach that targets the fastest functional recovery with adequate pain control while minimizing side effects, can be achieved with opioid minimization. Many different options for nonopioid multimodal analgesia exist and have been shown to be efficacious, with certain modalities being more beneficial for specific surgeries. This review will present the evidence and practical tips for these management strategies.
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Affiliation(s)
- Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, TVC 4619, Nashville, TN 37221, USA; Perioperative Medicine Fellowship, Hi-RiSE Perioperative Optimization Clinic, Perioperative Consult Service, VUMC ERAS Executive Steering Committee, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232, USA.
| | - Britany L Raymond
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, TVC 4619, Nashville, TN 37221, USA; Perioperative Medicine Fellowship, Hi-RiSE Perioperative Optimization Clinic, Perioperative Consult Service, VUMC ERAS Executive Steering Committee, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232, USA
| | - Anton Krige
- Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK
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Valsø Å, Rustøen T, Småstuen MC, Puntillo K, Skogstad L, Schou-Bredal I, Sunde K, Tøien K. Occurrence and characteristics of pain after ICU discharge: A longitudinal study. Nurs Crit Care 2021; 27:718-727. [PMID: 34382725 DOI: 10.1111/nicc.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pain is a serious problem for intensive care unit (ICU) patients, but we are lacking data on pain at the hospital ward after ICU discharge. AIMS AND OBJECTIVES To describe pain intensity, -interference with function and -location in patients up to 1 year after ICU discharge. To identify demographic and clinical variables and their association with worst pain intensity and pain interference. DESIGN A longitudinal descriptive secondary analysis of a randomized controlled trial on nurse-led follow-up consultations on post-traumatic stress and sense of coherence after ICU discharge. METHODS Pain intensity, -interference, and -location were measured using Brief Pain Inventory at the hospital ward and 3, 6, and 12 months after ICU discharge. For associations, data were analysed using multivariate linear mixed models for repeated measures. RESULTS Of 523 included patients, 68% reported worst pain intensity score above 0 (no pain) at the ward. Estimated means for worst pain intensity and -interference (from 0 to 10) after ICU discharge were 5.5 [CI 4.6-6.5] and 4.5 [CI 3.7-5.3], and decreased to 3.8 [CI 2.8-4.8] (P ≤ .001) and 2.9 [CI 2.1-3.7] after 12 months (P ≤ .001). Most common pain locations were abdomen (43%), lower lumbar back (28%), and shoulder/forearm (22%). At 12 months, post-traumatic stress (PTS) symptoms ≥25 (scale 10-70), female gender, shorter ICU stay, and more traumatic ICU memories were significantly associated with higher worst pain intensity. PTS symptoms ≥25, female gender, more traumatic ICU memories, younger age, and not having an internal medical diagnosis were significantly associated with higher pain interference. CONCLUSIONS Early after ICU discharge pain was present in 68% of patients. Thereafter, pain intensity and -interference declined, but pain intensity was still at a moderate level at 12 months. Health professionals should be aware of patients' pain and identify potentially vulnerable patients. IMPLICATION FOR PRACTICE Longitudinal assessment of factors associated with pain early after ICU discharge and the following year is a first step that could improve follow-up focus and contribute to reduced development of chronic pain.
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Affiliation(s)
- Åse Valsø
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Public Health, OsloMet-Oslo Metropolitan University of Oslo, Oslo, Norway
| | - Kathleen Puntillo
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Laila Skogstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Inger Schou-Bredal
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Unit for Breast- and Endocrine Surgery, Division Cancer, Oslo University Hospital, Oslo, Norway
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kirsti Tøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Bakshi SG, Rathod A, Salunkhe S. Influence of interpretation of pain scores on patients' perception of pain: A prospective study. Indian J Anaesth 2021; 65:216-220. [PMID: 33776112 PMCID: PMC7989498 DOI: 10.4103/ija.ija_130_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Aims: Assessment of pain using pain scales is essential. In the Numeric Rating Scale (NRS), patients are asked to score their pain intensity on a scale from 0 to 10 (10- worst pain). This requires some abstract thinking by the patient, also the pain scores (PS) may not essentially communicate the patients’ need for more analgesia. We planned a study to evaluate the change in patients’ self-assessed PS after understanding clinical interpretation of the NRS. Methods: This prospective study was registered after approval from our hospital ethics board. Sample size estimated for the trial was 360 patients. All postoperative patients were recruited after informed consent. Patients having prolonged stay in Intensive Care Unit (more than 48 h), or those who underwent emergency surgeries were excluded. During Acute Pain Service (APS) rounds, patients were asked to rate their PS on the NRS. This was followed by a briefing about the clinical interpretation of the scale, and the patients were asked to re score their pain using the same scale. The change in pain severity was compared using Chi-square test. Results: Following explanation, a change in severity was seen for PS at rest [X2 (9, N- 360) = 441, P < 0.001] and at movement [X2 (9, N- 360) = 508, P < 0.001]. Overall, a change in PS severity was seen in 162 patients (45%). A decrease and an increase in the severity of pain was seen in 119 and 41 patients respectively. Conclusion: Explaining the clinical interpretation of PS on a NRS does lead to a change in patients’ self-assessed PS.
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Affiliation(s)
- Sumitra G Bakshi
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Rathod
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Salunkhe
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Cho S, Kim YJ, Lee M, Woo JH, Lee HJ. Cut-off points between pain intensities of the postoperative pain using receiver operating characteristic (ROC) curves. BMC Anesthesiol 2021; 21:29. [PMID: 33494704 PMCID: PMC7831264 DOI: 10.1186/s12871-021-01245-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pain assessment and management are important in postoperative circumstances as overdosing of opioids can induce respiratory depression and critical consequences. We aimed this study to check the reliability of commonly used pain scales in a postoperative setting among Korean adults. We also intended to determine cut-off points of pain scores between mild and moderate pain and between moderate and severe pain by which can help to decide to use pain medication. Methods A total of 180 adult patients undergoing elective non-cardiac surgery were included. Postoperative pain intensity was rated with a visual analog scale (VAS), numeric rating scale (NRS), faces pain scale revised (FPS-R), and verbal rating scale (VRS). The VRS rated pain according to four grades: none, mild, moderate, and severe. Pain assessments were performed twice: when the patients were alert enough to communicate after arrival at the postoperative care unit (PACU) and 30 min after arrival at the PACU. The levels of agreement among the scores were evaluated using intraclass correlation coefficients (ICCs). The cut-off points were determined by receiver operating characteristic curves. Results The ICCs among the VAS, NRS, and FPS-R were consistently high (0.839–0.945). The pain categories were as follow: mild ≦ 5.3 / moderate 5.4 ~ 7.1 /severe ≧ 7.2 in VAS, mild ≦ 5 / moderate 6 ~ 7 / severe ≧ 8 in NRS, mild ≦ 4 / moderate 6 / severe 8 and 10 in FPS-R. The cut-off points for analgesics request were VAS ≧ 5.5, NRS ≧ 6, FPS-R ≧ 6, and VRS ≧ 2 (moderate or severe pain). Conclusions During the immediate postoperative period, VAS, NRS, and FPS-R were well correlated. The boundary between mild and moderate pain was around five on 10-point scales, and it corresponded to the cut-off point of analgesic request. Healthcare providers should consider VRS and other patient-specific signs to avoid undertreatment of pain or overdosing of pain medication.
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Affiliation(s)
- Sooyoung Cho
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea.
| | - Minjin Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, South Korea
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
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Frutiger M, Borotkanics R. Systematic Review and Meta-Analysis Suggest Strength Training and Workplace Modifications May Reduce Neck Pain in Office Workers. Pain Pract 2020; 21:100-131. [PMID: 32657531 DOI: 10.1111/papr.12940] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Neck pain is a burdensome musculoskeletal disorder in office workers. Workplace interventions aim to prevent and minimize the effect of neck pain and improve work quality. However, the summed effect of workplace interventions on neck pain in office workers remains unclear. This systematic review with meta-analysis and meta-regression evaluated the summed effect of workplace interventions on neck pain in office workers. METHODS We searched 7 electronic databases to January 2020 for randomized clinical trials. We selected studies, independently extracted data, and assessed risk of bias. Meta-analyses were carried out along with normalized trend plots. RESULTS Twenty-nine trials, including 8 of high quality, met our inclusion criteria. Normalized trend plots indicate that neck strengthening demonstrated the sharpest decrease in pain scores. The results of pre- and post-outcome measurement of the effect of activity performance and workplace modification showed significant improvements in self-reported neck pain (P ≤ 0.001). Meta-regression was used to evaluate the effect of time, but it was not significant. CONCLUSIONS There is low-quality evidence that neck strengthening and tailored workstation modifications are effective at reducing neck pain in office workers. Further high-quality research methodology, including clinicians, is important to evaluate this summed effect.
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Affiliation(s)
- Martin Frutiger
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, North Ryde, NSW, Australia
| | - Robert Borotkanics
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Liu S, Xie Y, Chen Q, Sun Y, Ding Z, Zhang Y, Chen S, Chen J. Tendon Healing Progression Evaluated With Magnetic Resonance Imaging Signal Intensity and Its Correlation With Clinical Outcomes Within 1 Year After Rotator Cuff Repair With the Suture-Bridge Technique. Am J Sports Med 2020; 48:697-705. [PMID: 32023083 DOI: 10.1177/0363546519899357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND After a rotator cuff (RC) is repaired, its signal intensity (SI) on magnetic resonance imaging (MRI) gradually changes to normal and could reflect the degree of RC healing. Nevertheless, it remains unclear how long it takes for SI to recover to normal and whether the SI progression correlates with clinical outcomes after RC repair (RCR). PURPOSE To serially evaluate the SIs of the repaired RC tendon on MRI and the postoperative clinical outcomes and then analyze the correlation between them. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study prospectively included 25 patients who underwent arthroscopic RCR with the suture-bridge technique between June 2016 and July 2017. Twenty-three patients accepted full follow-ups at 1, 3, 6, 9, and 12 months. Before surgery and at each follow-up, visual analog scale (VAS) for pain and 4 functional scores were evaluated: Constant-Murley score, American Shoulder and Elbow Surgeons shoulder evaluation form, modified University of California at Los Angeles score, and Fudan University shoulder score. The patients underwent MRI examinations at every follow-up. The values of the signal/noise quotient at the distal (SNQd) and proximal (SNQp) areas were calculated to evaluate the SI of the repaired tendon. The correlations of clinical outcomes with SNQd and SNQp values were analyzed, and subgroup analyses were performed. RESULTS Overall, the mean postoperative VAS score significantly decreased at postoperative 1 month (P < .001), and the functional scores were all significantly higher than the preoperative values at 6 months (all P < .001). SNQd and SNQp values were both significantly higher than normal at 1 and 3 months (all P < .001) and reduced to normal after 9 and 6 months, respectively. Correlation analyses showed that the SNQp value significantly correlated with VAS score (positive) and all functional scores (negative) at 1 and 3 months postoperatively. Further comparison indicated that the patients with VAS score >3 had higher SNQp values than patients with VAS score ≤3 at 1 and 3 months postoperatively (both P = .01). CONCLUSION After RCR with the suture-bridge technique, it took longer for SI to become relatively normal than it did to have a significant clinical improvement. Early after surgery (1-3 months), worse clinical outcome correlated with higher SI on proximal cuff tendon.
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Affiliation(s)
- Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxue Xie
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qingyan Chen
- Department of Biology, Boston University, Boston, Massachusetts, USA
| | - Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zheci Ding
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuhan Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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12
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Kaczynski K, Ely E, Gordon D, Vincent C, Waddell K, Wittmayer K, Bernhofer E. The Pediatric American Pain Society Patient Outcomes Questionnaire (Pediatric APS-POQ): Development and Initial Psychometric Evaluation of a Brief and Comprehensive Measure of Pain and Pain Outcomes in Hospitalized Youth. THE JOURNAL OF PAIN 2019; 21:633-647. [PMID: 31683024 DOI: 10.1016/j.jpain.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/16/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
Pediatric pain assessment in the hospital traditionally involves the patient's self-report of pain intensity using a numeric rating scale, which does not capture the complexity of the pain experience. No valid, comprehensive measure of pain in hospitalized youth exists. This study was designed to develop and conduct initial psychometric testing of the Pediatric American Pain Society Patient Outcomes Questionnaire (Pediatric APS-POQ), a comprehensive patient-reported measure of pain and pain outcomes in hospitalized youth. A multidisciplinary group of pediatric pain researchers and clinicians collaborated to adapt the adult APS-POQ Revised to pediatrics, including a patient-report and parent proxy version. The adapted measures were administered to 218 pediatric inpatients (age M = 13.4 years, 56% female) and 214 of their parents (80% mothers) at 4 US children's hospitals. The measure was feasible to administer within the inpatient setting and was acceptable and understandable to pediatric patients and their parents. Internal consistency was adequate for both patient-report and parent proxy (α = 0.77). Confirmatory factor analysis supported the following 6 domains, consistent with the adult measure: pain intensity, functional interference, emotional response, side effects, perceptions of care, and usual pain. Additional research is needed to further support the reliability and validity of this measure in diverse clinical populations. PERSPECTIVE: To reduce the impact of pain on hospitalized youth, pediatric pain assessment must move beyond ratings of pain intensity. The Pediatric APS-POQ provides a brief but comprehensive assessment of pain and pain outcomes in hospitalized children and adolescents, which will allow for greater individualization in hospital-based pain management and quality improvement purposes.
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Affiliation(s)
- Karen Kaczynski
- Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Debra Gordon
- Seattle Children's Hospital, Seattle, Washington
| | | | | | | | - Esther Bernhofer
- Cleveland Clinic Children's Hospital/Case Western Reserve University, Cleveland, Ohio
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13
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Hoofwijk DMN, Reij RRI, Rutten BPF, Kenis G, Theunissen M, Joosten EA, Buhre WF, den Hoogen NJ. Genetic polymorphisms and prediction of chronic post-surgical pain after hysterectomy-a subgroup analysis of a multicenter cohort study. Acta Anaesthesiol Scand 2019; 63:1063-1073. [PMID: 31206175 DOI: 10.1111/aas.13413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/26/2019] [Accepted: 05/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) is a serious problem. Clinical and psychological variables have not been able to explain all observed variance in prevalence and severity of CPSP. The first objective is to determine the association between genetic polymorphisms and the prevalence of CPSP after hysterectomy. The second objective is to analyze if the implementation of genetic polymorphisms into a previously performed clinical and psychological predictor analysis on the development of CPSP after hysterectomy will improve its discriminatory power. METHODS A prospective multicenter cohort study was performed in patients undergoing hysterectomy for benign indication. Clinical and psychological variables were collected by questionnaires in the week before surgery, post-operatively up to day 4, 3 and 12 months after hysterectomy. Blood was collected and 16 polymorphisms previously suggested to be correlated to CPSP (COMT, GCH1, KCNS1, CACNG2, and OPRM1) were genotyped. Logistic regression analyses were performed. RESULTS Three hundred and forty-five patients were available for the genetic analyses. The prevalence of CPSP 3 months post-operatively was 10.5% and after 12 months 7.9%. The polymorphism rs4818 within the COMT gene was associated with the prevalence of CPSP after 3 months. No polymorphisms were associated with CPSP after 12 months. The addition of rs4818 to the prediction model did not change its discriminatory power significantly. CONCLUSION The rs4818 polymorphism within the COMT gene was associated with the prevalence of CPSP 3 months after hysterectomy, but the implementation of rs4818 into the prediction model did not significantly improve the chance of identifying hysterectomy patients at risk for CPSP.
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Affiliation(s)
- Daisy M. N. Hoofwijk
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Roel R. I. Reij
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Bart P. F. Rutten
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology Maastricht University Medical Center+ Maastricht The Netherlands
| | - Gunter Kenis
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology Maastricht University Medical Center+ Maastricht The Netherlands
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Wolfgang F. Buhre
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
| | - Nynke J. den Hoogen
- Department of Anesthesiology and Pain Medicine Maastricht University Medical Center+ Maastricht The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences Maastricht University Medical Center+ Maastricht The Netherlands
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14
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de Joode SGCJ, Kalmet PHS, Fiddelers AAA, Poeze M, Blokhuis TJ. Long-term functional outcome after a low-energy hip fracture in elderly patients. J Orthop Traumatol 2019; 20:20. [PMID: 30976999 PMCID: PMC6459450 DOI: 10.1186/s10195-019-0529-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of hip fractures is increasing. Elderly patients with a hip fracture frequently present with comorbidities, which are associated with higher mortality rates. Clinical studies regarding long-term functional outcome and mortality in hip fractures are rare. The aim of this study was to analyse the functional outcome and the mortality rate after a follow-up of 5 years in elderly patients with a hip fracture. MATERIALS AND METHODS This combined retrospective and cross-sectional study included patients aged 65 years or older with a low energy hip fracture who underwent surgery in the Maastricht University Medical Center+, the Netherlands. Data such as demographics and mortality rates were retrospectively collected and functional outcome (i.e. mobility, pain, housing conditions and quality of life) was assessed by a questionnaire. RESULTS Two hundred and sixteen patients were included in this study (mean age 82.2, SD ± 7.5). No significant differences were found in pain before hip fracture and after 1-year and 5-year follow-ups. Long-term functional outcome deteriorated after a hip fracture, with a significant increase in the use of walking aids (p < 0.001), a significant decrease of patients living in a private home (p < 0.001), and a low physical quality of life (SF-12 PCS = 27.1). The mortality incidences after 30-day, 1-year and 5-year follow-ups were 7.9%, 37.0% and 69.4%, respectively. CONCLUSION Long-term functional outcome in elderly patients with hip fractures significantly deteriorated, with an increased dependency for mobility and housing conditions and a decreased physical quality of life. In addition, hip fractures are associated with high mortality rates at the 5-year follow-up. LEVEL OF EVIDENCE Level III, a retrospective cohort study.
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Affiliation(s)
- Stijn G C J de Joode
- Department of Trauma Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Pishtiwan H S Kalmet
- Department of Trauma Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | | | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Network Acute Care Limburg, Maastricht, The Netherlands.,Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Taco J Blokhuis
- Department of Trauma Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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15
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Vrancken D, Theunissen M, Joosten EA, Fiddelers AAA, Hoofwijk DMN, Buhre WFFA, Gramke HF, Stessel B. Procedure-Specific Pain Intensity Four Days After Day Surgery and the Relationship with Preoperative Pain: A Prospective Cohort Study. Anesth Pain Med 2019; 8:e81366. [PMID: 30719413 PMCID: PMC6347732 DOI: 10.5812/aapm.81366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Identification of painful procedures is essential for the development of procedure-specific pain-treatment schedules. The aim of this study was firstly, to analyze the prevalence of acute postsurgical pain (APSP) after various types of day surgery on the fourth postoperative day, and secondly, to assess the predictive value of preoperative pain for the development of APSP after different types of surgical procedures. Methods From November 2008 to April 2010, patients scheduled for elective day surgery were enrolled in this prospective cohort study. Data were collected one week preoperatively and four days postoperatively. The 11-point Numeric Rating Scale (NRS) was used for pain measurement. Moderate pain was defined as an NRS 4 to 5, and severe pain as an NRS > 5. The predictive value of preoperative pain for development of APSP was analyzed using a univariate logistic regression, stratified for the surgical procedure. Results From a total of 1123 included patients, 182 patients experienced moderate pain (16.3%) and 136 patients experienced severe pain (12.1%) on the fourth postoperative day. A large procedure-specific variability in APSP was observed, with shoulder, anal and dental surgery associated with the highest pain levels. Overall, preoperative pain significantly predicted postoperative pain on the fourth day (OR 4.45). This predictive value showed a procedure-specific variation and was not noted after various well-defined procedures. Conclusions The prevalence of moderate to severe APSP was high four days after day surgery and showed a significant procedure-specific variation. Furthermore, there was a strong relationship between preoperative and postoperative pain, likewise characterized by a significant procedure-specific variation.
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Affiliation(s)
- Dirk Vrancken
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium. Tel: +32-479439183,
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Audrey A. A. Fiddelers
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Daisy M. N. Hoofwijk
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang F. F. A. Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
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16
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Cunningham ME, Vogel AM. Analgesia, sedation, and delirium in pediatric surgical critical care. Semin Pediatr Surg 2019; 28:33-42. [PMID: 30824132 DOI: 10.1053/j.sempedsurg.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The alleviation of discomfort and distress is an essential component of the management of critically ill surgical patients. Pain and anxiety have multifocal etiologies that may be related to an underlying disease or surgical procedure, ongoing medical therapy, invasive monitors, an unfamiliar, complex and chaotic environment, as well as fear. Pharmacologic and non-pharmacologic therapies have complex risk benefit profiles. A fundamental understanding of analgesia, sedation, and delirium is essential for optimizing important outcomes in critically ill pediatric surgical patients. There has been a recent emphasis on goal directed, evidence based, and patient-centered management of the physical and psychological needs of these children. The purpose of this article is to review and summarize recent advances and describe current practice of these important subjects in the pediatric surgical intensive care environment.
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Affiliation(s)
- Megan E Cunningham
- Texas Children's Hospital, Division of Pediatric Surgery, Department of Surgery, 6701 Fannin Street, Houston, TX 77030, USA.
| | - Adam M Vogel
- Texas Children's Hospital, Division of Pediatric Surgery, Department of Surgery, 6701 Fannin Street, Houston, TX 77030, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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17
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Green KT, Wilson SM, Dennis PA, Runnals JJ, Williams RA, Bastian LA, Beckham JC, Dedert EA, Kudler HS, Straits-Tröster K, Gierisch JM, Calhoun PS. Cigarette Smoking and Musculoskeletal Pain Severity Among Male and Female Afghanistan/Iraq Era Veterans. PAIN MEDICINE 2018; 18:1795-1804. [PMID: 28340108 DOI: 10.1093/pm/pnw339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective Cigarette smoking and musculoskeletal pain are prevalent among Department of Veterans Affairs (VA) health care system users. These conditions frequently co-occur; however, there is limited empirical information specific to Afghanistan/Iraq era veterans. The present study sought to examine gender differences in the association between cigarette smoking and moderate to severe musculoskeletal pain in US veterans with Afghanistan/Iraq era service. Methods A random sample of 5,000 veterans with service after November 11, 2001, participated in a survey assessing health care needs and barriers to care. One thousand ninety veterans completed the survey assessing post-traumatic stress disorder (PTSD) symptoms, depressive symptoms, and current pain severity. Multivariate logistic regression was used to examine the association between gender, cigarette smoking status, and current moderate to severe musculoskeletal pain. Results Findings indicated a significant gender by smoking interaction on moderate/severe musculoskeletal pain, adjusting for age, self-reported race/ethnicity and weight status, combat exposure, probable PTSD, depressive symptoms, service-connected injury during deployment, and VA health care service utilization. Deconstruction of the interaction indicated that female veteran smokers, relative to female nonsmokers, had increased odds of endorsing moderate to severe musculoskeletal pain (odds ratio [OR] = 2.73, 95% confidence interval [CI] = 1.16-6.41), whereas this difference was nonsignificant for male veterans (OR = 1.03, 95% CI = 0.69-1.56). Conclusions Survey data from Operation Enduring Freedom/Operation Iraqi Freedom veterans suggest an association between current smoking, gender, and moderate to severe musculoskeletal pain. The stronger relationship between smoking and pain in women supports the need for interventional and longitudinal research that can inform gender-based risk factors for pain in veteran cigarette smokers.
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Affiliation(s)
- Kimberly T Green
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Sarah M Wilson
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Paul A Dennis
- Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jennifer J Runnals
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Rebecca A Williams
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lori A Bastian
- Department of Internal Medicine, Yale University, New Haven, CT, USA.,Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA
| | - Jean C Beckham
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Eric A Dedert
- Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Harold S Kudler
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kristy Straits-Tröster
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Phoenix VA Healthcare System, 650 E. Indian School Road, Phoenix, AZ, USA8
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Patrick S Calhoun
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA
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18
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Kent ML, Tighe PJ, Belfer I, Brennan TJ, Bruehl S, Brummett CM, Buckenmaier CC, Buvanendran A, Cohen RI, Desjardins P, Edwards D, Fillingim R, Gewandter J, Gordon DB, Hurley RW, Kehlet H, Loeser JD, Mackey S, McLean SA, Polomano R, Rahman S, Raja S, Rowbotham M, Suresh S, Schachtel B, Schreiber K, Schumacher M, Stacey B, Stanos S, Todd K, Turk DC, Weisman SJ, Wu C, Carr DB, Dworkin RH, Terman G. The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions. PAIN MEDICINE 2018; 18:947-958. [PMID: 28482098 PMCID: PMC5431381 DOI: 10.1093/pm/pnx019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Setting Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). Methods As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. Perspective The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Conclusions Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions.
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Affiliation(s)
- Michael L Kent
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Patrick J Tighe
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, FL, USA
| | - Inna Belfer
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Timothy J Brennan
- Department of Anesthesiology, University of Iowa, Iowa City, Iowa, IA, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, TN, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chester C Buckenmaier
- Defense and Veteran's Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert I Cohen
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - David Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, TN, USA
| | - Roger Fillingim
- Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Jennifer Gewandter
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Debra B Gordon
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, USA
| | - Robert W Hurley
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - John D Loeser
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, USA.,Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sean Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Samuel A McLean
- Departments of Anesthesiology and Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rosemary Polomano
- Department of Biobehavioral Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Siamak Rahman
- Department of Anesthesiology, University of California, Los Angeles, California, USA
| | - Srinivasa Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Rowbotham
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Santhanam Suresh
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bernard Schachtel
- Yale School of Public Health, New Haven, Connecticut, USA.,Schachtel Associates, Inc., Jupiter, Florida, USA
| | - Kristin Schreiber
- Department of Anesthesiology and Pain Management, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark Schumacher
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Brett Stacey
- Center for Pain Relief, University of Washington Medical Center, Seattle, Washington, USA
| | - Steven Stanos
- Swedish Pain Services, Swedish Health System, Seattle, Washington, USA
| | - Knox Todd
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, USA
| | - Steven J Weisman
- Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Wu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel B Carr
- Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Robert H Dworkin
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Gregory Terman
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, USA
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The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions. THE JOURNAL OF PAIN 2018; 18:479-489. [PMID: 28495013 DOI: 10.1016/j.jpain.2017.02.421] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (eg, pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. SETTING Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). METHODS As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. PERSPECTIVE The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. CONCLUSIONS Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions.
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External Validation and Modification of a Predictive Model for Acute Postsurgical Pain at Home After Day Surgery. Clin J Pain 2017; 33:405-413. [PMID: 27428546 PMCID: PMC5638419 DOI: 10.1097/ajp.0000000000000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In 2009, Gramke and colleagues have described predictive factors to preoperatively detect those at risk for moderate to severe acute postsurgical pain (APSP) after day surgery. The aim of the present study is to externally validate this initial model and to improve and internally validate a modified version of this model. MATERIALS AND METHODS Elective patients scheduled for day surgery were prospectively enrolled from November 2008 to April 2010. Model discrimination was quantified using the area under the receiver operating characteristic curve (AUC). Model calibration was assessed by visual inspection of the calibration plot. Subsequently, we modified (different assignment of type of surgery, different cutoff for moderate to severe APSP, continuous of dichotomized variables and testing of additional variables) and internally validated this model by standard bootstrapping techniques. RESULTS A total of 1118 patients were included. The AUC for the original model was 0.81 in the derivation data set and 0.72 in our validation data set. The model showed poorly calibrated risk predictions. The AUC of the modified model was 0.82 (optimism-corrected AUC=0.78). This modified model showed good calibration. CONCLUSIONS The original prediction model of Gramke and colleagues performed insufficiently on our cohort of outpatients with respect to discrimination and calibration. Internal validation of a modified model shows promising results. In this model, preoperative pain, patient derived expected pain, and different types of surgery are the strongest predictors of moderate to severe APSP after day surgery.
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Kaye AD, Helander EM, Vadivelu N, Lumermann L, Suchy T, Rose M, Urman RD. Consensus Statement for Clinical Pathway Development for Perioperative Pain Management and Care Transitions. Pain Ther 2017; 6:129-141. [PMID: 28853044 PMCID: PMC5693810 DOI: 10.1007/s40122-017-0079-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Indexed: 02/02/2023] Open
Abstract
The perioperative surgical home (PSH) model has been created with the intention to reduce costs and to improve efficiency of care and patient experience in the perioperative period. The PSH is a comprehensive model of care that is team-based and patient-centric. The team in each facility should be multidisciplinary and include the input of perioperative services leadership, surgical services, and support personnel in order to provide seamless care for the patient from the preoperative period when decision to undergo surgery is initially made to discharge and, if needed after discharge from the hospital, until full recovery is achieved. PSH is discussed in this consensus article with the emphasis on perioperative care coordination of patients with chronic pain conditions. Preoperative optimization can be successfully undertaken through patient evaluation, screening, and education. Many important positive implications in the PSH model, in particular for those patients with increased potential morbidity, mortality, and high-risk populations, including those with a history of substance abuse or anxiety, reflect a more modern approach to health care. Newer strategies, such as preemptive and multimodal analgesic techniques, have been demonstrated to reduce opioid consumption and to improve pain relief. Continuous catheters, ketamine, methadone, buprenorphine, and other modalities can be best delivered with the expertise of an anesthesiologist and a support team, such as an acute pain care coordinator. A physician-led PSH is a model of care that is patient-centered with the integration of care from multiple disciplines and is ideally suited for leadership from the anesthesia team. Optimum pain control will have a significant positive impact on the measures of the PSH, including lowering of complication rates, lowering of readmissions, improved patient satisfaction, reduced morbidity and mortality, and shortening of hospital stays. All stakeholders should work together and consider the PSH model to ensure the best quality of health care for patients undergoing surgery in the future. The pain management physician's role in the postoperative period should be focused on providing optimal analgesia associated with improved patient satisfaction and outcomes that result in reduced health care costs.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University, New Orleans, LA, USA
| | - Erik M Helander
- Department of Anesthesiology, Louisiana State University, New Orleans, LA, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Heaven, CT, USA
| | - Leandro Lumermann
- Department of Anesthesiology, Yale University School of Medicine, New Heaven, CT, USA
| | - Thomas Suchy
- Department of Anesthesiology, Yale University School of Medicine, New Heaven, CT, USA
| | - Margaret Rose
- Department of Anesthesiology, Yale University School of Medicine, New Heaven, CT, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Institute for Safety in Office-Based Surgery, Boston, MA, USA.
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Stessel B, Theunissen M, Marcus MA, Joosten EA, van Kuijk SMJ, Fiddelers AAA, Peters ML, Hoofwijk DMN, Buhre WFFA, Gramke HF. Prevalence and Predictors of Patient Nonadherence to Pharmacological Acute Pain Therapy at Home After Day Surgery: A Prospective Cohort Study. Pain Pract 2017; 18:194-204. [PMID: 28419729 DOI: 10.1111/papr.12589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/19/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Good adherence to prescribed analgesics can be crucial to suppress or even prevent acute postoperative pain after day surgery. The aim of this study was to analyze prevalence and predictors of analgesic nonadherence after day surgery. METHODS Elective patients scheduled for day surgery were prospectively enrolled from November 2008 to April 2010. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. The primary outcome parameter was analgesic nonadherence. Adherence was defined according to the patient's response to the questionnaire item "analgesia use as prescribed": full adherence, "yes"; partial adherence, "yes, sometimes"; nonadherence, "no." Bivariate and multivariate logistic regression analyses were performed to identify predictors of analgesic nonadherence. RESULTS A total of 1,248 patients were included. The prevalence rates of analgesic nonadherence and partial adherence were 21.6% and 20.0%, respectively, in the total study population but dropped to 9.4% and 19.8%, respectively, in patients with moderate to severe pain. Low postoperative pain intensity and short duration of surgery were the most important predictors of analgesic nonadherence. The most important preoperative predictors for analgesic nonadherence were low preoperative pain intensity, low preoperative expectations of pain, and low fear of short-term effects of surgery. CONCLUSION Analgesic nonadherence and partial adherence are common after day surgery but decrease as average pain intensity increases. Patients at risk for analgesic nonadherence can be identified during the preoperative period based on preoperative pain intensity, preoperative expectations of pain, and fear of surgery.
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Affiliation(s)
- Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium.,Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marco A Marcus
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Elbert A Joosten
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Audrey A A Fiddelers
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Network Acute Care Limburg, Maastricht, The Netherlands
| | - Madelon L Peters
- Department of Clinical Psychological Science, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daisy M N Hoofwijk
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wolfgang F F A Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Andersson V, Bergman S, Henoch I, Ene KW, Otterström-Rydberg E, Simonsson H, Ahlberg K. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017; 15:22-29. [DOI: 10.1016/j.sjpain.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Abstract
Background and aim
Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.
Methods
A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.
Results
When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.
Conclusions
This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.
Implications
Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.
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Affiliation(s)
- Viveka Andersson
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Department of Medicine , Hallands Hospital Varberg , Träslövsvägen 68, 432 37 , Varberg , Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine , Institute of Medicine, The Sahlgrenska Academy , University of Gothenburg , Box 457, 405 30 , Gothenborg , Sweden
- Spenshult Research and Development Centre , Bäckagårdsvägen 47, 302 74 , Halmstad , Sweden
| | - Ingela Henoch
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Angered Local Hospital , Halmtorget 1, 424 65 , Gothenburg , Sweden
| | - Kerstin Wickström Ene
- Department of Research, Development and Education , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Eva Otterström-Rydberg
- Department of Anesthesia and Intensive Care , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Hanna Simonsson
- Department of Surgery , Hallands Hospital , Halmstad , Lasarettsvägen, 302 33 Halmstad , Sweden
| | - Karin Ahlberg
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
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Barrington JW, Emerson RH, Lovald ST, Lombardi AV, Berend KR. No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA. Clin Orthop Relat Res 2017; 475:94-105. [PMID: 27339124 PMCID: PMC5174037 DOI: 10.1007/s11999-016-4931-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. QUESTIONS/PURPOSES (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA? (2) Do patients treated with liposomal bupivacaine-based PAI experience fewer opioid-related adverse events compared with patients treated with morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA? METHODS This multicenter, blind trial randomized 119 patients undergoing TKA with spinal anesthesia to receive spinal anesthesia plus periarticular injection with liposomal bupivacaine (40 patients), spinal anesthesia with bupivacaine plus intrathecal morphine (41 patients) but no liposomal bupivacaine injection, or spinal anesthesia with bupivacaine (38 patients) and no liposomal bupivacaine injection. The two groups that did not receive periarticular liposomal bupivacaine did receive periarticular injection with ropivacaine, and all three groups had ketorolac (30 mg) plus epinephrine (1:1000) in the periarticular injections. Patients in all three groups received identical perioperative multimodal analgesic and antiemetic drugs. All patients were analyzed in the group to which they were randomized and no patients were lost to followup. The primary study endpoints were visual analog score (VAS) for pain and narcotic use during postoperative day 1. Secondary endpoints included side effects associated with narcotic administration during the hospital stay. RESULTS Mean VAS pain in the liposomal bupivacaine PAI group was lower than that for the ropivacaine PAI group at 6 hours (1.8 ± 2.1 versus 3.3 ± 2.3, p = 0.005, mean difference: 1.5, 95% confidence interval [CI], 0.5-2.5) and 12 hours (1.5 ± 2.0 versus 3.3 ± 2.4, p < 0.001, mean difference: 1.8, 95% CI, 0.8-2.8) after surgery. The morphine spinal group had lower pain compared with the liposomal bupivacaine PAI group at 6 hours (0.9 ± 1.8 versus 1.8 ± 2.1, p = 0.035, mean difference: 1.0, 95% CI, 0.1-1.8), but there was no difference at 12 hours (0.8 ± 1.5 versus 1.5 ± 2.0, p = 0.086, mean difference: 0.7, 95% CI, -0.1 to 1.5). The magnitude of the differences at 6 and 12 hours are near the lower end of minimal clinically important differences reported in the literature, and thus the improvement shown in this study may only represent a small clinical improvement. Both the liposomal bupivacaine group (13% [five of 40]) and the ropivacaine group (5% [two of 38]) had fewer incidents of itching (pruritus) than the spinal morphine group (38% [15 of 41]) (p = 0.001). CONCLUSIONS This prospective multicenter three-arm blind randomized controlled trial showed potentially improved pain control at 6 and 12 hours in the liposomal bupivacaine and intrathecal morphine groups compared with the ropivacaine group at the cost of much higher incidences of pruritus (itching) in the intrathecal morphine group. Based on these results, we prefer the use of PAI with liposomal bupivacaine as an alternative to spinal anesthesia with intrathecal morphine as a result of similar postoperative pain control and the potential for reducing adverse events. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- John W. Barrington
- grid.418661.cPlano Orthopedic Sports Medicine and Spine Center, Plano, TX USA
| | | | - Scott T. Lovald
- grid.418983.f0000000096620001Exponent, Inc, 149 Commonwealth Drive, Menlo Park, CA 19104 USA
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Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors. J Arthroplasty 2016; 31:288-92. [PMID: 27318410 DOI: 10.1016/j.arth.2016.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It has been reported that pain-related outcomes after total knee arthroplasty (TKA) may vary with different analgesic techniques and with patient demographics. The purposes of this study were to compare local infiltration of regular bupivacaine (periarticular infiltration [PAI] group) vs liposomal bupivacaine (LBUP group) and to examine the effect of patient characteristics on postoperative pain after TKA. METHODS The study sample included 665 consecutive TKA cases performed between December 2011 and August 2013. The primary outcome measures were the average visual analog scale (VAS) pain score and the percent of VAS pain scores that indicated no pain. Multivariable regression analyses investigated the effect of age, race, ethnicity, body mass index, gender, surgeon, and analgesic protocol on outcomes. For the analgesic groups, the "PAI" group received injections of a cocktail including bupivacaine, ketorolac, and morphine, whereas the "LBUP" group received injections of LBUP. RESULTS The regression analysis demonstrated that postoperative pain was higher in females (P < .001) and younger patients (P < .001). Although overall average VAS pain scores were not significantly different, when specific postoperative days were evaluated, the LBUP group had lower pain scores from day 1 to 5 (P < .014). There were no differences in VAS scores based on patient body mass index (P = .250), race (P = .205), or ethnicity (P = .961) in this sample. CONCLUSION This multivariate regression analysis study showed that in patients undergoing primary TKA, postoperative pain was lower in males, older patients, and those treated with LBUP. Awareness of these factors may assist in developing patient-specific multimodal postoperative pain and education protocols that reduce opioid reliance and related adverse events.
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Chien CW, Bagraith K, Khan A, Deen M, Syu JJ, Strong J. Establishment of cutpoints to categorize the severity of chronic pain using composite ratings with Rasch analysis. Eur J Pain 2016; 21:82-91. [DOI: 10.1002/ejp.906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- C.-W. Chien
- Occupational Therapy Division; School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
- Department of Rehabilitation Sciences; The Hong Kong Polytechnic University; Kowloon Hong Kong (SAR) China
| | - K.S. Bagraith
- Occupational Therapy Division; School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
- Interdisciplinary Persistent Pain Centre; Gold Coast Hospital and Health Service; Gold Coast Qld Australia
| | - A. Khan
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - M. Deen
- Metro South Persistent Pain Management Service; Princess Alexandra Hospital; Woolloongabba Qld Australia
| | - J.-J. Syu
- School of Public Health; The University of Queensland; Brisbane Qld Australia
| | - J. Strong
- Occupational Therapy Division; School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
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Theunissen M, Peters ML, Schepers J, Maas JW, Tournois F, van Suijlekom HA, Gramke HF, Marcus MA. Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery. Medicine (Baltimore) 2016; 95:e3980. [PMID: 27367998 PMCID: PMC4937912 DOI: 10.1097/md.0000000000003980] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Chronic postsurgical pain (CPSP) is 1 important aspect of surgical recovery. To improve perioperative care and postoperative recovery knowledge on predictors of impaired recovery is essential. The aim of this study is to assess predictors and epidemiological data of CPSP, physical functioning (SF-36PF, 0-100), and global surgical recovery (global surgical recovery index, 0-100%) 3 and 12 months after hysterectomy for benign indication.A prospective multicenter cohort study was performed. Sociodemographic, somatic, and psychosocial data were assessed in the week before surgery, postoperatively up to day 4, and at 3- and 12-month follow-up. Generalized linear model (CPSP) and linear-mixed model analyses (SF-36PF and global surgical recovery index) were used. Baseline data of 468 patients were collected, 412 (88%) patients provided data for 3-month evaluation and 376 (80%) patients for 12-month evaluation.After 3 and 12 months, prevalence of CPSP (numeric rating scale ≥ 4, scale 0-10) was 10.2% and 9.0%, respectively, SF-36PF means (SD) were 83.5 (20.0) and 85.9 (20.2), global surgical recovery index 88.1% (15.6) and 93.3% (13.4). Neuropathic pain was reported by 20 (5.0%) patients at 3 months and 14 (3.9%) patients at 12 months. Preoperative pain, surgery-related worries, acute postsurgical pain on day 4, and surgery-related infection were significant predictors of CPSP. Baseline level, participating center, general psychological robustness, indication, acute postsurgical pain, and surgery-related infection were significant predictors of SF-36PF. Predictors of global surgical recovery were baseline expectations, surgery-related worries, American Society of Anesthesiologists classification, type of anesthesia, acute postsurgical pain, and surgery-related infection.Several predictors were identified for CPSP, physical functioning, and global surgical recovery. Some of the identified factors are modifiable and optimization of patients' preoperative pain status and psychological condition as well as reduction of acute postsurgical pain and surgery-related infection may lead to improvement of outcome.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht UMC+
- Correspondence: Maurice Theunissen, Department of Anesthesiology and Pain Management, Maastricht UMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands ()
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht
| | - Jan Schepers
- Department of Clinical Psychological Science, Maastricht University, Maastricht
| | | | - Fleur Tournois
- Department of Gynaecology, Maastricht UMC+, Maastricht/Orbis Medical Center, Sittard-Geleen
| | - Hans A. van Suijlekom
- Department of Anesthesiology and Pain Management, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Marco A.E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht UMC+
- Department of Anesthesiology, ICU, and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
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Intravenous Ibuprofen for Treatment of Post-Operative Pain: A Multicenter, Double Blind, Placebo-Controlled, Randomized Clinical Trial. PLoS One 2016; 11:e0154004. [PMID: 27152748 PMCID: PMC4859493 DOI: 10.1371/journal.pone.0154004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs are often used as components of multimodal therapy for postoperative pain management, but their use is currently limited by its side effects. The specific objective of this study was to evaluate the efficacy and safety of a new formulation of intravenous (IV) ibuprofen for the management of postoperative pain in a European population. METHODS AND FINDINGS A total of 206 patients from both abdominal and orthopedic surgery, were randomly assigned in 1:1 ratio to receive 800 mg IV-ibuprofen or placebo every 6 hours; all patients had morphine access through a patient controlled analgesia pump. The primary outcome measure was median morphine consumption within the first 24 hours following surgery. The mean±SEM of morphine requirements was reduced from 29,8±5,25 mg to 14,22±3,23 mg (p = 0,015) and resulted in a decrease in pain at rest (p = 0,02) measured by Visual Analog Scale (VAS) from mean±SEM 3.34±0,35 to 0.86±0.24, and also in pain during movement (p = 0,02) from 4.32±0,36 to 1.90±0,30 in the ibuprofen treatment arm; while in the placebo group VAS score at rest ranged from 4.68±0,40 to 2.12±0,42 and during movement from 5.66±0,42 to 3.38±0,44. Similar treatment-emergent adverse events occurred across both study groups and there was no difference in the overall incidence of these events. CONCLUSIONS Perioperative administration of IV-Ibuprofen 800 mg every 6 hours in abdominal surgery patient's decreases morphine requirements and pain score. Furthermore IV-Ibuprofen was safe and well tolerate. Consequently we consider appropriate that protocols for management of postoperative pain include IV-Ibuprofen 800 mg every 6 hours as an option to offer patients an analgesic benefit while reducing the potentially risks associated with morphine consumption. TRIAL REGISTRATION EU Clinical Trials Register 2011-005007-33.
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Pedras S, Carvalho R, Pereira MDG. Sociodemographic and clinical characteristics of patients with diabetic foot ulcer. Rev Assoc Med Bras (1992) 2016; 62:171-8. [DOI: 10.1590/1806-9282.62.02.171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/21/2014] [Indexed: 11/21/2022] Open
Abstract
Summary Introduction: Diabetic foot is one of the most serious complications of diabetes affecting about 15% of all diabetes patients, and it is the leading cause of nontraumatic lower limb amputations. This study presents a sociodemographic and clinical characterization of patients with diabetic foot ulcer indicated for amputation surgery. Methods: A cross-sectional study with 206 patients with type 2 diabetes and a diabetic foot ulcer indicated for amputation surgery. Patients were assessed on sociodemographic and clinical characteristics, pain intensity and pain interference, after answering the Brief Pain Inventory, and on pain descriptors according to the Douleur Neuropathique 4. Results: Most patients were male, with little formal education and a mean age of 66 years. They had been diagnosed with type 2 diabetes for 18 years on average, and with diabetic foot ulcer on average 4 years prior to the assessment. About 59% of patients experienced pain in the lower limb that significantly affect all areas of their functioning. Conclusion: The social demographic variables play an important role in diabetic foot ulceration. Given that the neuropathic ulcers are more easily preventable, systematic monitoring of patients with neuropathy is important. In patients with neuroischemic foot, strategies to cope or manage more efficiently the pain are paramount. Intervention should be multidisciplinary and take into account sociodemographic and clinical factors, as well as the presence, intensity and interference of pain in the patient's daily life activities and whether the patient has family or caregiver support.
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Albayrak I, Apiliogullari S, Erkocak OF, Kavalci H, Ozerbil OM, Levendoglu F. Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain. J Natl Med Assoc 2016; 108:236-243. [DOI: 10.1016/j.jnma.2016.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 01/23/2023]
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Ross S, Tang S, Eliasziw M, Lier D, Girard I, Brennand E, Dederer L, Jacobs P, Robert M. Transobturator tape versus retropubic tension-free vaginal tape for stress urinary incontinence: 5-year safety and effectiveness outcomes following a randomised trial. Int Urogynecol J 2015; 27:879-86. [DOI: 10.1007/s00192-015-2902-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/15/2015] [Indexed: 11/28/2022]
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Prevalence and Predictive Factors of Chronic Postsurgical Pain and Poor Global Recovery 1 Year After Outpatient Surgery. Clin J Pain 2015; 31:1017-25. [DOI: 10.1097/ajp.0000000000000207] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hoofwijk DMN, Fiddelers AAA, Emans PJ, Joosten EA, Gramke HF, Marcus MAE, Buhre WFFA. Prevalence and Predictive Factors of Chronic Postsurgical Pain and Global Surgical Recovery 1 Year After Outpatient Knee Arthroscopy: A Prospective Cohort Study. Medicine (Baltimore) 2015; 94:e2017. [PMID: 26559300 PMCID: PMC4912294 DOI: 10.1097/md.0000000000002017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Outpatient knee arthroscopy is one of the most commonly performed surgical procedures. Previous research has demonstrated that chronic postsurgical pain (CPSP) after outpatient surgery is prevalent. Our objective was to determine the prevalence and predictive factors of CPSP and Global Surgical Recovery (GSR) 1 year after knee arthroscopy.A prospective longitudinal cohort study was performed. Patients were included during an 18-month period. Data were collected by using 3 questionnaires: at 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale (NRS) was defined as moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor GSR. Stepwise logistic regression analysis was performed to determine which variables were predictors for CPSP and poor GSR.The prevalence of moderate to severe preoperative pain in patients undergoing knee arthroscopy (n = 104) was 71.2%, of acute postsurgical pain 37.5%, and of CPSP 32.7%. Risk factors for CPSP were the presence of preoperative pain and preoperative analgesic use, with odds ratios of 6.31 (1.25-31.74) and 4.36 (1.58-12.07), respectively. The prevalence of poor GSR 1 year after outpatient knee arthrosocpy was 50.0%. Poor GSR 4 days after the surgery was a risk factor with an odds ratio of 8.38 (0.92-76.58) and quality of life 4 days after surgery was a protective factor with and odds ratio of 0.10 (0.02-0.64).Both CPSP and poor GSR are common 1 year after knee arthroscopy. Patients at risk for CPSP can be identified during the preoperative phase. Prediction of poor GSR 1 year after surgery is mainly related to early postoperative recovery.
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Affiliation(s)
- Daisy M N Hoofwijk
- From the Department of Anesthesiology and Pain Treatment (DMNH, AAAF, EAJ, H-FG, MAEM, WFFAB); Department of Orthopedic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands (PJE); and Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Qatar (MAEM)
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Barrington JW, Olugbode O, Lovald S, Ong K, Watson H, Emerson RH. Liposomal Bupivacaine: A Comparative Study of More Than 1000 Total Joint Arthroplasty Cases. Orthop Clin North Am 2015; 46:469-77. [PMID: 26410636 DOI: 10.1016/j.ocl.2015.06.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pain after total joint arthroplasty (TJA) can be severe and difficult to control. A single-dose local analgesic delivers bupivacaine in a liposomal time-release platform. In 2248 consecutive patients with hip and knee arthroplasty, half (Pre) were treated using a well-established multimodal analgesia, including periarticular injection (PAI), and half had the PAI substituted for a liposomal bupivacaine injection technique (Post). Pain scores were significantly lower for patients in the Post group for both hip and knee procedures. A large series of patients who had TJA experienced pain relief after the introduction of liposomal bupivacaine as part of an established multimodal protocol.
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Affiliation(s)
- John W Barrington
- Plano Orthopedic Sports Medicine & Spine Center, 5228 W Plano Pkwy, Plano, TX 75093, USA
| | - Oluseun Olugbode
- Texas Center for Joint Replacement, 6020 West Parker Road, Suite 470, Plano, TX 75093, USA
| | - Scott Lovald
- Exponent, Inc, 149 Commonwealth Drive, Menlo Park, CA 94025, USA.
| | - Kevin Ong
- Exponent, Inc, 3440 Market Street, Suite 600, Philadelphia, PA 19104, USA
| | - Heather Watson
- Exponent, Inc, 149 Commonwealth Drive, Menlo Park, CA 94025, USA
| | - Roger H Emerson
- Texas Center for Joint Replacement, 6020 West Parker Road, Suite 470, Plano, TX 75093, USA
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de Jong AEE, Bremer M, Hofland HWC, Schuurmans MJ, Middelkoop E, van Loey NEE. The visual analogue thermometer and the graphic numeric rating scale: a comparison of self-report instruments for pain measurement in adults with burns. Burns 2014; 41:333-40. [PMID: 25262546 DOI: 10.1016/j.burns.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/16/2014] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
Abstract
To evaluate the adequacy of pain management in burn care, pain measurement is essential. The visual analogue thermometer (VAT) and graphic numeric rating scale (GNRS) are frequently used self-report instruments for burn pain. To legitimise their interchangeable use in research and practice, we aimed to compare self-reports obtained by the VAT and GNRS, the ability of the scales to differentiate background from procedural pain, and to compare potential cutpoints. Adults with acute burns (N=319) participated in the study (67% male, mean age 40.3 years (SD 16), mean TBSA 9.9% (SD 10.4). Correlation coefficients between VAT and GNRS were 0.64 and 0.55 for, respectively, morning and afternoon background pain and 0.51 for procedural pain (p<0.01). VAT scores were lower than GNRS scores for all pain types (p<0.01). Both scales could differentiate background from procedural pain: procedural pain was higher (p<0.01). The standardized response mean was moderate (0.518 for VAT and 0.571 for GNRS). Self-reported thresholds for 'unacceptable pain' by GNRS were higher than by VAT (p<0.001). ROC analyses showed that the highest sensitivity was reached for pain score 2 for both scales. The results suggest that the instruments cannot be used interchangeably without taking their differences into account.
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Affiliation(s)
- A E E de Jong
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands; Association of Dutch Burn Centres, Beverwijk, The Netherlands.
| | - M Bremer
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Burn Centre, Martini Hospital, Groningen, The Netherlands
| | - H W C Hofland
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
| | - M J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Middelkoop
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N E E van Loey
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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Theunissen M, Peters ML, Schouten EGW, Fiddelers AAA, Willemsen MGA, Pinto PR, Gramke HF, Marcus MAE. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery. PLoS One 2014; 9:e100225. [PMID: 24960025 PMCID: PMC4069058 DOI: 10.1371/journal.pone.0100225] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ. METHODS Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N = 3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis. RESULTS EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1-4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5-10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765-0.920 (SFQ-total), 0.766-0.877 (SFQ-s), and 0.628-0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity. DISCUSSION The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Erik G. W. Schouten
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Audrey A. A. Fiddelers
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark G. A. Willemsen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patrícia R. Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco A. E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Anesthesia/ICU, Pain and Palliative Care, Hamad Medical Corporation, Doha, Qatar
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Dufeu N, Marchand-Maillet F, Atchabahian A, Robert N, Ait Yahia Y, Milan D, Robert C, Coroir M, Beaussier M. Efficacy and safety of ultrasound-guided distal blocks for analgesia without motor blockade after ambulatory hand surgery. J Hand Surg Am 2014; 39:737-43. [PMID: 24582844 DOI: 10.1016/j.jhsa.2014.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the suitability of ultrasound-guided (USG), single-injection distal block(s) for pain management after outpatient hand and wrist bone surgery. METHODS We conducted a retrospective review of 125 of 198 consecutive ambulatory surgery patients who underwent hand and wrist bone surgery between June 2010 and January 2012. All patients received a USG axillary block using a short-acting local anesthetic (lidocaine) and secondary 1, 2, or 3 (median, radial, or ulnar) USG distal analgesic block(s) using a long-acting local anesthetic (ropivacaine). All patients were contacted by phone on the first postoperative day. All patients received a concomitant prescription of acetaminophen and nonsteroidal anti-inflammatory drugs with opioids as a rescue treatment. Effectiveness and duration of the distal nerve blocks, compliance with analgesic treatment and rescue opioids requirement, opioid-related side effects, prolonged upper limb motor block, quality of sleep on first postoperative night, and patient satisfaction were evaluated. RESULTS Most distal analgesic blocks were effective (120 of 125; 96%), with an average duration of nearly 12 hours On the first day after surgery, 28 patients (23%) had a numeric verbal scale greater than 3, although 14 of them had taken the rescue opioids. No patient reported prolonged motor blockade or insensate limb. Opioid-related side effects occurred in 23% of patients. CONCLUSIONS After hand and wrist bone surgery, USG selective distal blocks using a long-acting local anesthetic, combined with oral analgesics, were effective in a large majority of patients. However, pain control was suboptimal for some especially painful procedures such as wrist surgery, trapeziometacarpal arthrodesis, and finger amputation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Nicolas Dufeu
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Florence Marchand-Maillet
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Arthur Atchabahian
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Nicolas Robert
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Yasmine Ait Yahia
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Didier Milan
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Cyrille Robert
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Marine Coroir
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY
| | - Marc Beaussier
- Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
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Stephens K, Cooper BA, West C, Paul SM, Baggott CR, Merriman JD, Dhruva A, Kober KM, Langford DJ, Leutwyler H, Luce JA, Schmidt BL, Abrams GM, Elboim C, Hamolsky D, Levine JD, Miaskowski C, Aouizerat BE. Associations between cytokine gene variations and severe persistent breast pain in women following breast cancer surgery. THE JOURNAL OF PAIN 2014; 15:169-80. [PMID: 24411993 PMCID: PMC4331184 DOI: 10.1016/j.jpain.2013.09.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/21/2013] [Accepted: 09/03/2013] [Indexed: 01/02/2023]
Abstract
UNLABELLED Persistent pain following breast cancer surgery is a significant clinical problem. Although immune mechanisms may play a role in the development and maintenance of persistent pain, few studies have evaluated for associations between persistent breast pain following breast cancer surgery and variations in cytokine genes. In this study, associations between previously identified extreme persistent breast pain phenotypes (ie, no pain vs severe pain) and single nucleotide polymorphisms (SNPs) spanning 15 cytokine genes were evaluated. In unadjusted analyses, the frequency of 13 SNPs and 3 haplotypes in 7 genes differed significantly between the no pain and severe pain classes. After adjustment for preoperative breast pain and the severity of average postoperative pain, 1 SNP (ie, interleukin [IL] 1 receptor 2 rs11674595) and 1 haplotype (ie, IL10 haplotype A8) were associated with pain group membership. These findings suggest a role for cytokine gene polymorphisms in the development of persistent breast pain following breast cancer surgery. PERSPECTIVE This study evaluated for associations between cytokine gene variations and the severity of persistent breast pain in women following breast cancer surgery. Variations in 2 cytokine genes were associated with severe breast pain. The results suggest that cytokines play a role in the development of persistent postsurgical pain.
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Affiliation(s)
- Kimberly Stephens
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Claudia West
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Christina R Baggott
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - John D Merriman
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Heather Leutwyler
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Judith A Luce
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Brian L Schmidt
- Department of Oral Maxillofacial Surgery, New York University College of Dentistry, New York, New York
| | - Gary M Abrams
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, San Francisco, California.
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Frey-Law LA, Lee JE, Wittry AM, Melyon M. Pain rating schema: three distinct subgroups of individuals emerge when rating mild, moderate, and severe pain. J Pain Res 2013; 7:13-23. [PMID: 24379696 PMCID: PMC3873848 DOI: 10.2147/jpr.s52556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background While the validity of pain assessment has been well documented, the underlying schema (ie, organized, preconceived ideas) of how individuals interpret numerical pain ratings is not well understood. This study’s objectives were to examine numerical pain intensity ratings, from (0 to 10 cm on the visual analog scale [VAS]) across multiple severities of commonly experienced acute pain conditions to determine whether the ratings differed between these pain conditions and/or between individuals. Methods A community sample (N=365, 66% female) rated their anticipated pain intensity (VAS) for threshold, mild, moderate, severe, and tolerance level, using several common pain conditions: headache, toothache, joint injury, delayed-onset muscle soreness, burns, and “general pain.” Results Cluster analysis revealed three subgroups of individuals, suggesting three types of underlying pain rating schema: 1) Low Rating subgroup (low VAS pain intensity ratings across all the pain severity categories); 2) Low/High Rating subgroup (low VAS pain intensity rating for mild, but high VAS pain intensity rating for severe pain); and 3) High Rating subgroup (high VAS pain intensity ratings across all the pain severity categories). Overall, differences between pain conditions were small: muscle soreness pain intensity was consistently rated lower than the other pain types across severities. The highest pain ratings varied between joint injury and general pain, depending on severity level. No effects of sex or current experience of pain were noted. Conclusion The results indicate that: 1) three distinct pain schemas were present in this community-based sample, indicating significant variation in how pain scales are utilized and/or interpreted between clusters of individuals; 2) pain ratings vary by condition, but these differences are minor; and 3) pain rating schemas are not significantly different between males and females or between individuals with and without current pain.
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Affiliation(s)
- Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, USA
| | - Jennifer E Lee
- Mount Mercy University, Department of Psychology, Cedar Rapids, IA, USA ; College of Nursing, The University of Iowa, IA, USA
| | - Alex M Wittry
- Department of Emergency Medicine, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Carr ECJ, Meredith P, Chumbley G, Killen R, Prytherch DR, Smith GB. Pain: a quality of care issue during patients' admission to hospital. J Adv Nurs 2013; 70:1391-403. [PMID: 24224703 DOI: 10.1111/jan.12301] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/22/2022]
Abstract
AIM To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge. BACKGROUND The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals. DESIGN A descriptive cross-sectional exploratory design. METHOD A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge. FINDINGS A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs. CONCLUSION Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience.
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Affiliation(s)
- Eloise C J Carr
- Faculty of Graduate Studies, University of Calgary, Alberta, Canada
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Myrvik MP, Brandow AM, Drendel AL, Yan K, Hoffmann RG, Panepinto JA. Clinically meaningful measurement of pain in children with sickle cell disease. Pediatr Blood Cancer 2013; 60:1689-95. [PMID: 23776145 PMCID: PMC3993972 DOI: 10.1002/pbc.24624] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Limited understanding of the interpretability of patient-reported pain scores may impact pain management. The current study assessed the minimal clinically significant improvement in pain and pain scores signifying patient-reported need for medication and treatment satisfaction in patients with sickle cell disease (SCD). PROCEDURE Patients, 8-18-years-old, with SCD were recruited while receiving treatment for pain. Patients completed initial pain severity ratings using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Serial assessments of pain severity, pain relief, perceived need for medication, and treatment satisfaction were completed in the emergency department and the hospitalization. Data were used to calculate the minimal clinically significant improvement in pain and pain scores associated with perceived need for pain medication and treatment satisfaction. RESULTS Twenty-eight patients completed 305 assessments during 37 total visits. A decrease in pain severity score of 0.97 cm for the VAS and 0.9 for the NRS was found to be the minimum clinically significant improvement in pain. Pain scores >7.45 cm on the VAS or 7.5 on the NRS were suggestive of patient-reported need for pain medication. Pain scores <7.35 cm on the VAS or 8.5 on the NRS were suggestive of patient-reported treatment satisfaction discrimination. CONCLUSIONS The minimal clinical significant improvement was defined for the VAS and NRS and both scales were able to discriminate between important clinical findings including pain relief, need for pain medication, and treatment satisfaction. Collectively, this study provides data to improve our understanding of pain ratings of pediatric patients with SCD.
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Affiliation(s)
- Matthew P Myrvik
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Amanda M Brandow
- Medical College of Wisconsin,Division of Pediatric Hematology/Oncology/Transplant
| | - Amy L Drendel
- Medical College of Wisconsin,Division of Pediatric Emergency Medicine
| | - Ke Yan
- Medical College of Wisconsin,Quantitative Health Sciences
| | | | - Julie A Panepinto
- Medical College of Wisconsin,Division of Pediatric Hematology/Oncology/Transplant
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Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One 2013; 8:e73917. [PMID: 24058502 PMCID: PMC3772812 DOI: 10.1371/journal.pone.0073917] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/24/2013] [Indexed: 12/27/2022] Open
Abstract
Persistent post-surgical pain (PPSP) is a major clinical problem with significant individual, social and health care costs. The aim of this study was to examine the joint role of demographic, clinical and psychological risk factors in the development of moderate and severe PPSP after Total Knee and Hip Arthroplasty (TKA and THA, respectively). This was a prospective study wherein a consecutive sample of 92 patients were assessed 24 hours before (T1), 48 hours after (T2) and 4–6 months (T3) after surgery. Hierarchical logistic regression analyses were performed to identify predictors of moderate and severe levels of PPSP. Four to six months after TKA and THA, 54 patients (58.7%) reported none or mild pain (Numerical Rating Scale: NRS ≤3), whereas 38 (41.3%) reported moderate to severe pain (NRS >3). In the final multivariate hierarchical logistic regression analyses, illness representations concerning the condition leading to surgery (osteoarthritis), such as a chronic timeline perception of the disease, emerged as a significant predictor of PPSP. Additionally, post-surgical anxiety also showed a predictive role in the development of PPSP. Pre-surgical pain was the most significant clinical predictive factor and, as expected, undergoing TKA was associated with greater odds of PPSP development than THA. The findings on PPSP predictors after major joint arthroplasties can guide clinical practice in terms of considering cognitive and emotional factors, together with clinical factors, in planning acute pain management before and after surgery.
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Affiliation(s)
- Patrícia R. Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Health Psychology Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Teresa McIntyre
- Texas Institute for Measurement, Evaluation and Statistics (TIMES) and Department of Psychology, University of Houston, Houston, United States of America
| | - Ramón Ferrero
- Alto Ave Hospital Center, Orthopedics Unit, Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Vera Araújo-Soares
- Health Psychology Group, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Pinto PR, McIntyre T, Ferrero R, Araújo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res 2013; 6:691-703. [PMID: 24072977 PMCID: PMC3783511 DOI: 10.2147/jpr.s45827] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4-6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post-surgical pain. Future prospective studies should therefore collect TKA and THA samples wherein patients are homogeneous for demographic and presurgical clinical issues. Overall, these findings contribute to a small but growing body of literature documenting persistent post-surgical pain after major arthroplasty, conducted in different countries and across different health care settings.
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Affiliation(s)
- Patrícia R Pinto
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal ; Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal ; Health Psychology Group, Newcastle University, Newcastle, UK
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Gardner SE, Blodgett NP, Hillis SL, Borhart E, Malloy L, Abbott L, Pezzella P, Jensen M, Sommer T, Sluka KA, Rakel BA. HI-TENS reduces moderate-to-severe pain associated with most wound care procedures: a pilot study. Biol Res Nurs 2013; 16:310-9. [PMID: 23956353 DOI: 10.1177/1099800413498639] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study systematically examined pain associated with wound care procedures (WCPs) and evaluated the effectiveness of high-intensity transcutaneous electrical nerve stimulation (HI-TENS) for reducing this pain in a two-phase design. Phase 1 (N = 57) examined patient, wound, and procedural factors, as well as analgesic intake, associated with WCPs. Pain during the WCPs was rated on a 0-10 numerical scale. Subjects reported a mean pain of 6.0 (standard deviation 3.04) during Phase 1, with 43 (75.4%) subjects experiencing moderate or severe pain (i.e., ≥4). Subjects who received opioid and/or nonopioid analgesia 1 hr before or during the WCPs (36.8%) reported significantly higher pain levels than those who had not received analgesia (p = .013). In Phase 2, 23 subjects with ≥4 pain during Phase 1 had HI-TENS applied to the area surrounding the wound during the WCPs. HI-TENS significantly reduced WCP pain by a mean of 2.0 (±2.31; effect size = 0.67; p = .001). This effect was significant for subjects with severe Phase 1 pain (i.e., ≥8; effect size = 1.00; p = .007) but not for subjects with moderate Phase 1 pain (i.e., 4-7; effect size = 0.40; p = .053). These findings demonstrate that pain during WCPs is a significant problem, that nurses appropriately administer analgesics but these are not sufficient, and that using HI-TENS may further reduce pain, particularly in patients experiencing severe WCP pain.
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Affiliation(s)
- Sue E Gardner
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | - Stephen L Hillis
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ellen Borhart
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Lynna Malloy
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Linda Abbott
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Pat Pezzella
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Marge Jensen
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Teresa Sommer
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Barbara A Rakel
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Predictors of Acute Postsurgical Pain and Anxiety Following Primary Total Hip and Knee Arthroplasty. THE JOURNAL OF PAIN 2013; 14:502-15. [DOI: 10.1016/j.jpain.2012.12.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/15/2012] [Accepted: 12/31/2012] [Indexed: 11/20/2022]
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Lindberg MF, Grov EK, Gay CL, Rustøen T, Granheim TI, Amlie E, Lerdal A. Pain characteristics and self-rated health after elective orthopaedic surgery - a cross-sectional survey. J Clin Nurs 2013; 22:1242-53. [DOI: 10.1111/jocn.12149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Maren F Lindberg
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Ellen K Grov
- Department of Nursing Science; Faculty of Medicine; University of Oslo; Blindern Oslo Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing; University of California; San Francisco CA USA
- Department of Research and Development; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care; Department of Research and Development; Oslo University Hospital; Oslo Norway
- Lovisenberg Diakonale University College; Oslo Norway
| | - Tove I Granheim
- Postoperative Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Einar Amlie
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Anners Lerdal
- Department of Research; Lovisenberg Diakonale Hospital; Oslo Norway
- Lovisenberg Diakonale University College; Oslo Norway
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Zoëga S, Ward S, Gunnarsdottir S. Evaluating the quality of pain management in a hospital setting: testing the psychometric properties of the Icelandic version of the revised American Pain Society patient outcome questionnaire. Pain Manag Nurs 2012; 15:143-55. [PMID: 23318415 DOI: 10.1016/j.pmn.2012.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 11/27/2022]
Abstract
Pain management is an important aspect of providing quality health care, and monitoring patient-related outcomes is a recommended quality improvement practice. Valid and reliable tools are needed for this purpose. The American Pain Society Patient Outcome Questionnaire (APS-POQ) is widely used to measure quality of pain management. The APS-POQ was recently revised to reflect advances in pain management. The purpose of this study was to test the psychometric properties of the revised version in Icelandic patients in the hospital setting. The questionnaire was translated according to an adaptation of Brislin's model. Data were collected from 143 patients on 23 wards in a university hospital. Participants were ≥ 18 years old, hospitalized for >24 hours, alert, not too ill to participate, and in pain ≥ 1 on a 0-10 scale in the past 24 hours. Mean (SD) age was 66 (18) years, 51.4% were women, 48.6% men. Principal component analysis with varimax rotation confirmed a five-component structure, but four items lowered reliability and were removed from the scales. The final version consists of four components, with Cronbach α >.70, explaining 64.2% of the variance. Participants had little difficulty in answering the questionnaire, but two additional items about participation in decisions and pain medications were added in response to patients' comments and suggestions. Administering the Icelandic version of the APS-POQ-R was found to be feasible, and the questionnaire has acceptable construct validity and reliability. The results support the use of the APS-POQ-R-I to evaluate the quality of pain management in hospitals in Iceland.
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Affiliation(s)
- Sigridur Zoëga
- Landspítali-National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland.
| | - Sandra Ward
- School of Nursing, University of Wisconsin-Madison
| | - Sigridur Gunnarsdottir
- Landspítali-National University Hospital of Iceland, University of Iceland, Reykjavik, Iceland
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Pinto PR, McIntyre T, Fonseca C, Almeida A, Araújo-Soares V. Pre- and post-surgical factors that predict the provision of rescue analgesia following hysterectomy. Eur J Pain 2012; 17:423-33. [PMID: 22893516 DOI: 10.1002/j.1532-2149.2012.00205.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND To better manage post-surgical pain, standardized analgesic protocols allow for rescue analgesia (RA). This study seeks to determine which pre- and post-surgical clinical and patient-related factors, in addition to post-surgical pain, may influence health care professional decisions on RA administration. METHODS A consecutive sample of 185 women, submitted to hysterectomy for benign disorders, was assessed 24 h before (time 1; T1) and 48 h after (time 2; T2) surgery. At T1, baseline demographic, clinical and psychological predictors were assessed and at T2, post-surgical pain, anxiety and RA administration were recorded. RESULTS After controlling for post-surgical acute pain intensity, logistic regression results revealed several pre-surgical (T1) and surgical factors associated with post-surgical RA: having other previous pain states [odds ratio (OR), 4.551; 95% confidence interval (CI), 1.642-12.611, p = 0.004], being anaesthetized with only general or loco-regional anaesthesia (OR, 5.349; 95% CI, 1.976-14.483, p = 0.001) and pre-surgical fear of immediate consequences of surgery (OR, 1.306; 95% CI, 1.031-1.655, p = 0.027). Concerning post-surgical variables, higher pain intensity (OR, 1.591; 95% CI, 1.353-1.871, p < 0.001) and post-surgical anxiety (OR, 1.245; 95% CI, 1.084-1.430, p = 0.002) were significantly associated with RA provision. CONCLUSIONS Health care decision making to administer RA might be influenced not only by post-surgical pain intensity but also by pre-surgical and surgical clinical factors, such as previous pain and type of anaesthesia. Patient-related psychological characteristics, such as pre-surgical fear and post-surgical anxiety, may also play a role in decision making on RA provision. Implications for practice are discussed.
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Affiliation(s)
- P R Pinto
- Life and Health Sciences Research Institute-ICVS, School of Health Sciences, University of Minho, Braga, Portugal
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Gilbertson-White S, Aouizerat BE, Jahan T, Paul SM, West C, Schumacher K, Dodd MJ, Rabow M, Abu Raddaha AH, Miaskowski C. Determination of cutpoints for low and high number of symptoms in patients with advanced cancer. J Palliat Med 2012; 15:1027-36. [PMID: 22853731 DOI: 10.1089/jpm.2012.0045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
While patients with advanced cancer experience a wide range of symptoms, no work has been done to determine an optimal cutpoint for a low versus a high number of symptoms. Analytic approaches that established clinically meaningful cutpoints for the severity of cancer pain and fatigue provided the foundation for this study. The purpose of this study was to determine the optimal cutpoint for low and high numbers of symptoms using a range of potential cutpoints and to determine if those cutpoints distinguished between the two symptom groups on demographic and clinical characteristics and depression, anxiety, and quality of life (QOL). Patients with advanced cancer (n=110) completed a symptom assessment scale, and measures of depression, anxiety, and QOL. Combinations of cutpoints were tested to yield one- and two-cutpoint solutions. Using analysis of variance for QOL scores, the F-ratio that indicated the highest between-group difference was determined to be the optimal cutpoint between low and high number of symptoms. A cutpoint of ≤ 12 symptoms (i.e., 0-12 is low, 13-32 is high) was the optimal cutpoint for total number of symptoms. Significant differences in depression, anxiety, and QOL scores validated this cutpoint. Psychological symptoms had higher occurrence rates in the high symptom group. Findings suggest that a threshold exists between a low and a high number of symptoms in patients with advanced cancer. Psychological symptoms were significantly different between patients in the low versus high symptom groups and may play an important role in QOL outcomes in patients with advanced cancer.
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