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Lovasi O, Gaál P, Frank K, Lám J. Acute Pain Services and pain-related patient-reported outcomes in Hungarian hospitals. Perioper Med (Lond) 2024; 13:18. [PMID: 38475942 DOI: 10.1186/s13741-024-00373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Postoperative pain management is an important part of surgical care, where Acute Pain Service offers added value in terms of patient outcomes and costs. The technology, however, has hardly been adopted in Hungary, with only two hospitals operating Acute Pain Service and whose performance has not been evaluated yet. This research compared pain management outcomes of surgical, orthopedic, and traumatology patients in Hungarian hospitals with and without Acute Pain Service. METHODS We recruited 348 patients, 120 in the APS group and 228 in the control group, whose experience was surveyed with an adapted version of the American Pain Society Patient Outcome Questionnaire. The questionnaire covered pain intensity, pain interference with physical and emotional functions, side effects, patient satisfaction, information received, and participation in treatment decisions. The differences were analyzed by Fisher's exact test and Mann-Whitney U test. RESULTS The APS group showed better results with lower pain intensity scores regarding worst postoperative pain (χ2 = 18.919, p = 0.0043). They reported less pain interference with activities in bed (χ2 = 21.978, p = 0.0006) and out of bed (χ2 = 14.341, p = 0.0129). Furthermore, patients in the APS group experienced fewer pain-management-related side effects, like nausea (χ2 = 15.240, p = 0.0101), drowsiness (χ2 = 26.965, p = 0.0001), and dizziness (χ2 = 13.980, p = 0.0124). However, patient information (χ2 = 3.480, p = 0.0945) and patient satisfaction (χ2 = 5.781, p = 0.2127) did not differ significantly between the two groups. CONCLUSIONS Our findings confirm earlier international evidence on the benefits of Acute Pain Service in postoperative pain management and support the wider adoption of the technology in Hungarian hospitals. Nevertheless, close attention should be paid to patient information and involvement as better outcomes alone do not necessarily increase patient satisfaction.
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Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary.
| | - Péter Gaál
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
- Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, Targu Mures, Romania
| | - Krisztián Frank
- Szekszárd District Office of the Government Office of Tolna County, Szekszárd, Hungary
| | - Judit Lám
- Health Services Management Training Center, Semmelweis University, Budapest, Hungary
- NEVES Society for Patient Safety, Budapest, Hungary
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van den Heuvel SA, van Boekel RL, Cox FJ, Ferré F, Minville V, Stamer UM, Vissers KC, Pogatzki-Zahn EM. Perioperative pain management models in four European countries: A narrative review of differences, similarities and future directions. Eur J Anaesthesiol 2024; 41:188-198. [PMID: 37889549 DOI: 10.1097/eja.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
There is general agreement that acute pain management is an important component of perioperative medicine. However, there is no consensus on the best model of care for perioperative pain management, mainly because evidence is missing in many aspects. Comparing the similarities and differences between countries might reveal some insights into different organisational models and how they work. Here, we performed a narrative review to describe and compare the structures, processes and outcomes of perioperative pain management in the healthcare systems of four European countries using Donabedian's framework as a guide. Our comparison revealed many similarities, differences and gaps. Different structures of acute pain services in the four countries with no common definition and standards of care were found. Protocols have been implemented in all countries and guidelines in some. If outcome is assessed, it is mainly pain intensity, and many patients experiencing more intense pain than others have common risk factors (e.g. preoperative pain, preoperative opioid intake, female sex and young age). Outcome assessment beyond pain intensity (such as pain-related physical function, which is important for early rehabilitation and recovery) is currently not well implemented. Developing common quality indicators, a European guideline for perioperative pain management (e.g. for patients at high risk for experiencing severe pain and other outcome parameters) and common criteria for acute pain services might pave the way forward for improving acute pain management in Europe. Finally, the education of general and specialist staff should be aligned in Europe, for example, by using the curricula of the European Pain Federation (EFIC).
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Affiliation(s)
- Sandra A van den Heuvel
- From the Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands (SAvdH, RLvB, KCV), Department of Anaesthesiology and Critical Care, Royal Brompton & Harefield Hospitals part of GSST, London, United Kingdom (FJC), Département d'Anaesthésie-Réanimation, Hôpital Pierre-Paul Riquet, Centre Hospitalo-universitaire Purpan, Toulouse, France (FF, VM), Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (UMS) and Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Muenster, Muenster, Germany (EMPZ)
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Mahyar L, Missair A, Buys MJ, Kou A, Benedetti de Marrero E, Sandbrink F, Matadial CM, Mariano ER. National review of acute pain service utilization, models of care, and clinical practices within the Veterans Health Administration. Reg Anesth Pain Med 2024; 49:117-121. [PMID: 37286296 DOI: 10.1136/rapm-2023-104610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) is the largest healthcare network in the USA and has been a national leader in opioid safety for acute pain management. However, detailed information on the availability and characteristics of acute pain services within its facilities is lacking. We designed this project to assess the current state of acute pain services within the VHA. METHODS A 50-question electronic survey developed by the VHA national acute pain medicine committee was emailed to anesthesiology service chiefs at 140 VHA surgical facilities within the USA. Data collected were analyzed by facility complexity level and service characteristics. RESULTS Of the 140 VHA surgical facilities contacted, 84 (60%) completed the survey. Thirty-nine (46%) responding facilities had an acute pain service. The presence of an acute pain service was associated with higher facility complexity level designation. The most common staffing model was 2.0 full-time equivalents, which typically included at least one physician. Services performed most by formal acute pain programs included peripheral nerve catheters, inpatient consult services, and ward ketamine infusions. CONCLUSIONS Despite widespread efforts to promote opioid safety and improve pain management, the availability of dedicated acute pain services within the VHA is not universal. Higher complexity programs are more likely to have acute pain services, which may reflect differential resource distribution, but the barriers to implementation have not yet been fully explored.
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Affiliation(s)
- Lauren Mahyar
- Anesthesiology Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Andres Missair
- Anesthesiology Service, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Michael J Buys
- Anesthesiology Service, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Friedhelm Sandbrink
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Christina M Matadial
- Anesthesiology Service, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Sun J, Li N, Liu B, Duan G, Zheng H, Cao X, Wang M, Zhang Z, Zhang X. Efficacy and safety of patient-controlled intravenous analgesia after APS team standardized postoperative pain management: A 6-year experience of an acute pain service in 107802 Chinese patients. Heliyon 2024; 10:e24387. [PMID: 38312661 PMCID: PMC10834482 DOI: 10.1016/j.heliyon.2024.e24387] [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: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
There are few studies on the impact of postoperative pain management (such as Acute Pain Service, APS) on the prognosis of patients, especially the research on large samples, even less data on Chinese patients. It is reported that only 25.12 % of hospitals in China have established APS or similar teams, and less than 10 % of them are responsible for the whole process of postoperative analgesia services. Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology has established a professional APS team led by anesthesiologists (TJ-APS), and has a standardized workflow and management system. Based on the TJ-APS standardized postoperative pain management, the incidence and adverse effects of postoperative pain in different types of surgical patients were analyzed. In total, 107,802 patients receiving intravenous PCA from the Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected between January 2016 and December 2021, which were under TJ-APS standardized postoperative analgesia process, postoperative analgesia strategy based on the principle of "low opioid, multimodal, specialization and individualization", as well as regular ward rounds and 24-h on call on-duty system. We assessed the incidence and adverse effects of postoperative pain in different types of surgical patients. Based on the TJ-APS standardized postoperative pain management, the incidence of poor postoperative analgesia in patients with intravenous PCA is significantly lower than that reported in the current literature (20 %), and mainly occurs in biliary-pancreatic surgery, extrahepatic surgery and gastrointestinal surgery. The overall incidence of adverse effects was 5.52 %, of which nausea and vomiting was the highest, especially among gynecological tumors and gynecological patients, which were 10.75 % and 8.68 % respectively, but both were lower than the level reported in the current literature (20 %). This APS multimodal management and analgesia process can provide reference and guidance for PCA management of postoperative acute pain.
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Affiliation(s)
- Jiaoli Sun
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ningbo Li
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Baowen Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Hua Zheng
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xueqin Cao
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Mao Wang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhifa Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xianwei Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Pellegrino PR, Are M. Pain management in cancer surgery: Global inequities and strategies to address them. J Surg Oncol 2023; 128:1032-1037. [PMID: 37818914 DOI: 10.1002/jso.27441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 10/13/2023]
Abstract
Among patients undergoing surgical oncologic operations, patients in low- and middle-income countries are at particularly high risk for inadequate perioperative analgesia. This article reviews some of the guiding pillars of pain management for cancer surgery, including use of regional analgesia and acute pain service consultation, multimodal adjunctive analgesia, and judicious opioid use while presenting data on international disparities for each pillar and proposing strategies to address these inequities.
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Affiliation(s)
- Peter Ricci Pellegrino
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Madhuri Are
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Lu J, Chen M, He G, Chen B, Wang R. Evaluating clinical pharmacists' involvement in postoperative acute pain services: a multicenter survey in Guangdong Province, China. Front Pharmacol 2023; 14:1283071. [PMID: 37849733 PMCID: PMC10577220 DOI: 10.3389/fphar.2023.1283071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Objective: Postoperative pain management is an important part of surgical pharmacy. Postoperative acute pain services in China are in their initial stages. This survey aimed to investigate the attitudes, involvement, and knowledge of clinical pharmacists in China regarding postoperative acute pain services. The results can provide valuable information to guide clinical pharmacists in developing targeted strategies to improve their postoperative acute pain service capabilities. Methods: A questionnaire was distributed to the pharmacy departments of 133 grade A tertiary hospitals in Guangdong province, and the responses were collected electronically. Results: 123 completed questionnaires were collected from clinical pharmacists. Although 95.93% of clinical pharmacists believed they should participate in postoperative pain services, only 62.6% reported substantial involvement. Overall satisfaction with the postoperative pain service was 93.5%. Understanding of non-steroidal anti-inflammatory drugs and opioid analgesics by clinical pharmacists was comparable (p > 0.05). Furthermore, 98.37% of clinical pharmacists desired systematic learning in postoperative pain management, and 40.65% expressed a strong need. Conclusion: Clinical pharmacists in China demonstrate a positive attitude toward participating in postoperative acute pain services. However, the actual level of involvement was concerning, and the lack of systematic training and well-established work protocols may be contributing factors. Efforts should be made to establish comprehensive and standardized processes and work protocols for postoperative acute pain services and provide systematic and hierarchical professional training to enhance clinical pharmacists' capabilities in postoperative acute pain services.
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Affiliation(s)
- Junxiong Lu
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingzhen Chen
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guansheng He
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Binwei Chen
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ruolun Wang
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Lovasi O, Lám J, Frank K, Schutzmann R, Gaál P. The First Comprehensive Survey of the Practice of Postoperative Pain Management in Hungarian Hospitals - a Descriptive Study. Pain Manag Nurs 2023; 24:342-349. [PMID: 36642581 DOI: 10.1016/j.pmn.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/20/2022] [Accepted: 12/10/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pain management is a key issue in health care. Providers adopt promising technological developments, like Acute Pain Service, at differing speeds, with countries, such as the USA and Germany taking the lead. Where Hungary stands is unknown, as the practice of pain management has not yet been comprehensively reviewed in that country. AIM To explore the practice of postoperative pain management in Hungarian hospitals by addressing the questions of who is responsible for it, who measures pain and how, what kind of pain relief technologies are used, and who takes care of patients during duty hours. METHODS We carried out a survey covering Hungarian hospitals with operational license for surgery, traumatology, orthopedics and anesthesiology between December 2019 and March 2020. The response rate was 72%, and we analyzed 135 questionnaires. RESULTS We identified only 2 hospitals with an Acute Pain Service. In the majority of hospitals, the attending physician orders pain relief therapy. During duty hours the surgeon on duty takes care of pain management in 52.1% of the cases. Among pain relief therapies, intravenous infusions (74.1%) and oral medication (67.4%) are the most frequent. Ward nurses measure postoperative pain (77.8%) with unidimensional scales. According to 59.7% of the respondents, pain is not measured and documented at rest. Written protocols are available in 34.4% of the departments. CONCLUSIONS Compared with other countries, pain management in Hungary lags behind with significant room for improvement. Development and implementation of pain management protocols with appropriate education is the key intervention point.
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Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Budapest, Hungary.
| | - Judit Lám
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Krisztián Frank
- Szekszárd District Office of the Government Office of Tolna County, Szekszárd, Hungary
| | - Réka Schutzmann
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Péter Gaál
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary; Sapientia Hungarian University of Transylvania, Faculty of Technical and Human Sciences, Department of Applied Social Sciences, Targu Mures, Romania
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Wiekamp CM. Telepain During the COVID-19 Pandemic. Pain Manag Nurs 2021; 23:76-78. [PMID: 34953673 PMCID: PMC8602967 DOI: 10.1016/j.pmn.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/19/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022]
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Lovasi O, Lám J, Schutzmann R, Gaál P. Acute Pain Service in Hungarian hospitals. PLoS One 2021; 16:e0257585. [PMID: 34550982 PMCID: PMC8457450 DOI: 10.1371/journal.pone.0257585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Surgical procedures play an increasing role among health technologies to treat diseases. Pain often accompanies such diseases, both as a result of their pathology, but also as the side-effect of the intervention itself, and it is not only a burdensome subjective feeling, but adversely affects the recovery process, can induce complications and increases treatment costs. Acute Pain Service Teams are becoming increasingly widespread in hospitals to address post-operative pain, yet we have so far no data on how many hospitals have actually adopted this technology in Hungary. Objectives The main objectives of our study were to assess the prevalence of Acute Pain Service Teams, map their structure and operation, as well as to understand the barriers and conducive factors of their establishment in Hungarian hospitals. Methods We carried out a survey among the 72 hospitals with surgical departments. The questionnaire was filled in by 52 providers, which gave us a response rate of 72.2%. Results Our results show, that only two of the responding hospitals have Acute Pain Service Teams albeit their structure and operation are in line with the literature. In the 50 hospitals without such teams, financing difficulties and human resources shortages are mentioned to be the most important obstacles of their establishment, but the lack of initiative and interest on the part of the specialities concerned are also an important barrier. Conclusions Lagging behind the more affluent EU member states, but similarly to other Central and Eastern European countries, Acute Pain Service has been hardly adopted by Hungarian hospitals. Hungarian health professionals know the technology and would support its wider introduction, if the technical feasibility barriers could be overcome. Health policy should play a more active role to facilitate change in this area, the investment in which promises a substantial return in terms of health gains and cost savings.
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Affiliation(s)
- Orsolya Lovasi
- School of PhD Studies, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Judit Lám
- Semmelweis University Health Services Management Training Centre, Budapest, Hungary
| | - Réka Schutzmann
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Péter Gaál
- Semmelweis University Health Services Management Training Centre, Budapest, Hungary
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Jepegnanam C, Bull E, Bansal S, McCarthy D, Booth M, Purser E, Makaka T, Shapley G, Cooper J, Probert J, Malpus Z. The role of the psychologist in the inpatient pain service: development and initial outcomes. Br J Pain 2021; 15:163-174. [PMID: 34055338 PMCID: PMC8138620 DOI: 10.1177/2049463720926212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM This article describes the development and initial evaluation of introducing a psychologist role within an adult inpatient pain service (IPS) in a large North West of England National Health Service (NHS) trust. BACKGROUND The role of a psychologist in the management of outpatient chronic pain has been well documented, but their role within the IPS is less well described and rarely evaluated. We describe the development of a psychologist role within the team and initial service evaluation outcomes. METHODS Following an initial needs assessment, a band 8c psychologist joined the IPS one day per week offering brief one-to-one psychological interventions to people struggling with acute or chronic pain in hospital referred by inpatient pain team. The psychologist had an indirect role offering training, supervision and support to members of the inpatient pain team. Regarding direct patient work, following psychometric screening for pain-related disability and distress, a cognitive behavioural therapy (CBT) approach was applied including identifying unhelpful beliefs about pain, psychoeducation about acute and persistent pain, developing and sharing formulations, skills training including breathing and relaxation exercises and where appropriate, signposting onto an outpatient chronic pain services for further pain self-management advice (e.g. pain management programme. To explore the impact of this direct intervention, a prospective service evaluation with a controlled before and after design was conducted. This compared (a) number of admissions and (b) length-of-stay outcomes in the 12 months following psychometric screening for patients who received psychological input (n = 34, the treatment group) and a sample who did not receive input because of discharge before intervention or non-availability of the psychologist, for example, annual leave (n = 30, control group). Demographic information and summaries of psychometric questionnaires were also analysed. RESULTS Of the sample of 64 patients, 50 were women, ages ranged from 18-80 years, 72% reported being currently unemployed or off sick from work and on screening and 39% and 48% met criteria for severe depression and pain-related anxiety, respectively. Hospital admissions in the intervention group reduced significantly (by 60%) in the 12 months following screening but increased (by 7%) for the control group (F(1,62) = 7.21, p = .009). Days of stay in hospital reduced significantly more (by 84%) in the intervention group than in the control group (by 41%) (F(1,62) = 8.90, p = .004). Illustrated case studies of brief psychological intervention with three people struggling with pain-related distress are presented. CONCLUSIONS The psychologist became a valuable member of the multi-disciplinary IPS team, offering brief direct and indirect psychological interventions. While a relatively small sample, our prospective service evaluation data suggest brief psychological intervention may contribute to reduced length of stay and hospital admissions for people experiencing pain-related distress in hospital.
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Affiliation(s)
- Chandran Jepegnanam
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Eleanor Bull
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Sujesh Bansal
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - David McCarthy
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Maureen Booth
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Elizabeth Purser
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Tecla Makaka
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Gemma Shapley
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Jo Cooper
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Jill Probert
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoey Malpus
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
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Sriganesh K, Bidkar PU, Krishnakumar M, Singh GP, Hrishi AP, Jangra K. Perioperative Analgesia in Neurosurgery (PAIN): A national survey of pain assessment and management among neuroanesthesiologists of India. Int J Clin Pract 2021; 75:e13718. [PMID: 32966673 DOI: 10.1111/ijcp.13718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Perioperative pain assessment and management in neurosurgical patients varies widely across the globe. There is lack of data from developing world regarding practices of pain assessment and management in neurosurgical population. This survey aimed to capture practices and perceptions regarding perioperative pain assessment and management in neurosurgical patients among anesthesiologists who are members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) and evaluated if hospital and pain characteristics predicted the use of structured pain assessment protocol and use of opioids for postoperative pain management. METHODS A 26-item English language questionnaire was administered to members of ISNACC using Kwiksurveys platform after ethics committee approval. Our outcome measures were adoption of structured protocol for pain assessment and opioid usage for postoperative pain management. RESULTS The response rate for our survey was 55.15% (289/524). One hundred eighteen (41%) responders informed that their hospital setup had a structured pain protocol while 43 (15%) responders reported using opioids for postoperative pain management. Predictors of the use of structured pain protocol were private setup (odds ratio [OR] 2.64; 95% confidence interval [CI] 1.52-4.59; P = .001), higher pain intensity (OR 0.37; 95% CI 0.21-0.64; P < .001) and use of pain scale (OR 7.94; 95% CI 3.99-15.81; P < .001) while availability of structured pain protocol (OR 2.04; 95% CI 1.02-4.05; P = .043) was the only significant variable for postoperative opioid use. CONCLUSIONS Less than half of the Indian neuroanesthesiologists who are members of ISNACC use structured protocol for pain assessment and very few use opioids for postoperative pain management in neurosurgical patients.
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Affiliation(s)
- Kamath Sriganesh
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Prasanna Udupi Bidkar
- Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
| | | | | | - Ajay Prasad Hrishi
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Kiran Jangra
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Polo-Santos M, Videla-Cés S, Pérez-Hernández C, Mayoral-Rojals V, Ribera-Canudas MV, Sarría-Santamera A. An Update on Resources, Procedures and Healthcare Provision in Pain Units: A Survey of Spanish Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020451. [PMID: 33430012 PMCID: PMC7826932 DOI: 10.3390/ijerph18020451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
Multidisciplinary pain treatment units are recommended to provide comprehensive diagnosis and treatment of chronic pain, a complex clinical syndrome and one of the leading causes of disability worldwide. The objective of this study was to provide updated results on the situation of pain treatment units in Spain and to determine compliance with recommendations proposed by de Spanish Ministry of Health (SMH). A cross-sectional, prospective, multicenter survey was performed, collecting data on resources, procedures and healthcare provision. Between March and May 2019, the Spanish Pain Society sent an invitation letter to 183 pain units with a link to the questionnaire. Sixty-nine units from 13 regions agreed to participate. According to the International Association for the Study of Pain criteria, only 12 units were classified as multidisciplinary pain centers. Most (95.7%) were in hospitals, 82.6% from the public sector, and 46.4% had protocols to coordinate with primary care. Interviewees rated the adequacy of facilities at 6.3 (from 0 to 10). Moreover, 67% of interviewees found that there were insufficient staff, with no mental health professionals, physical therapists or social workers in 49.3%, 87.0% and 97.1% units, respectively. Only 24 pain units had a day hospital, 44.9% offered psychological interventions, and 79.7% supported teaching and research activities. Results suggest that a small proportion of Spanish pain units meet the national standards for multidisciplinary pain units proposed by the SMH.
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Affiliation(s)
- Mar Polo-Santos
- Agencia de Evaluación de Tecnologías Sanitarias del Instituto de Salud Carlos III-Avenida Monforte de Lemos 5, 28029 Madrid, Spain
- Spanish Network of Health Services Research and Chronic Diseases (REDISSEC) (MPS, ASS), 28029 Madrid, Spain;
- Correspondence:
| | - Sebastián Videla-Cés
- Societat Catalana de Dolor, Academia Ciències Mediques de Catalunya i de Balears, 08017 Barcelona, Spain; (S.V.-C.); (M.V.R.-C.)
- Unidad de Soporte a la Investigación Clínica, Departamento de Farmacología Clínica, Hospital Universitario de Bellvitge-IDIBELL, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Concha Pérez-Hernández
- Sociedad Española del Dolor, Paseo de la Castellana 241, 28046 Madrid, Spain; (C.P.-H.); (V.M.-R.)
- Unidad del dolor Hospital Universitario de la Princesa, 28006 Madrid, Spain
| | - Víctor Mayoral-Rojals
- Sociedad Española del Dolor, Paseo de la Castellana 241, 28046 Madrid, Spain; (C.P.-H.); (V.M.-R.)
- Unidad de dolor Hospital Universitario de Bellvitge-IDIBELL, 08907 Barcelona, Spain
| | - Mª Victoria Ribera-Canudas
- Societat Catalana de Dolor, Academia Ciències Mediques de Catalunya i de Balears, 08017 Barcelona, Spain; (S.V.-C.); (M.V.R.-C.)
| | - Antonio Sarría-Santamera
- Spanish Network of Health Services Research and Chronic Diseases (REDISSEC) (MPS, ASS), 28029 Madrid, Spain;
- Departament of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek Khans St, Nur-Sultan 010000, Kazakhstan
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L'Hermite J, Pagé MG, Chevallier T, Occean B, Viel E, Bredeau O, Lefrant JY, Cuvillon P. Characterisation of pragmatic postoperative PAin Trajectories over seven days and their association with CHronicity after 3 months: a prospective, pilot cohort study (PATCH study). Anaesth Crit Care Pain Med 2020; 40:100793. [PMID: 33359373 DOI: 10.1016/j.accpm.2020.100793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reliable outcome measurement providing information both on early and late postoperative pain outcomes are still lacking. The purpose of this study was: 1) to characterise postoperative pain trajectories according to an innovative pragmatic concept: ideal pain trajectory (rapid and sustained pain relief) vs non-ideal pain trajectories (late, transient, or no pain relief); and 2) to assess the incidence of persistent post-surgical pain (PPSP) and the potential association between non-ideal pain trajectories and PPSP. METHODS This prospective observational pilot cohort study was performed from March until June 2016. A total of 344 patients undergoing major general surgery were invited to complete a self-assessment of pain intensity using numerical rating scale (NRS; 0 = no pain to 10 = worst pain) from day 1 until day 7 after surgery, in order to establish their pain trajectory. Three months after surgery, patients were screened for PPSP. RESULTS Rest pain score was analysed in 308 participants. Among them, 210 (68% - 95% CI: 63-73) had an "ideal" pain trajectory, while 98 (32% - 95% CI: 27-37) had "non-ideal" pain trajectories. Three months after surgery, 31% (95% CI: 26-37) reported PPSP. Multivariable analysis showed that "non-ideal" pain trajectories [OR 2.25; (95% CI: 1.26-4.01) P = 0.006] were significantly associated with PPSP. CONCLUSIONS The present study proposes an innovative pragmatic concept of postoperative pain trajectories: ideal vs non-ideal pain trajectories, providing information both on acute postoperative pain resolution and early identification patients at risk for developing PPSP. TRIAL REGISTRATION NCT02599233; November, 6, 2015, with clinicaltrials.gov.
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Affiliation(s)
- Joël L'Hermite
- Division of Anaesthesia Intensive Care Pain and Emergency, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - M Gabrielle Pagé
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Department of Anaesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Thierry Chevallier
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Bob Occean
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Eric Viel
- Division of Anaesthesia Intensive Care Pain and Emergency, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Olivier Bredeau
- Division of Anaesthesia Intensive Care Pain and Emergency, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Jean-Yves Lefrant
- Division of Anaesthesia Intensive Care Pain and Emergency, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Philippe Cuvillon
- Division of Anaesthesia Intensive Care Pain and Emergency, CHU Nîmes, Univ Montpellier, Nîmes, France
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Mitra S, Jain K, Singh J, Jindal S, Saxena P, Singh M, Saroa R, Ahuja V, Kang J, Garg S. Does an acute pain service improve the perception of postoperative pain management in patients undergoing lower limb surgery? A prospective controlled non-randomized study. J Anaesthesiol Clin Pharmacol 2020; 36:187-194. [PMID: 33013033 PMCID: PMC7480304 DOI: 10.4103/joacp.joacp_104_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/11/2019] [Indexed: 11/05/2022] Open
Abstract
Background and Aim: An acute pain service (APS) has been running in our institute since April 2013 and is managed by the Department of Anesthesia and Intensive Care. However, it is not clear to what extent the patients feel benefited from the APS. The aim of the study was to compare the perception of postoperative pain management in patients receiving care under APS with those receiving routine postoperative pain relief following lower limb surgery. Material and Methods: This was a prospective, hospital-based, controlled non-randomized study. American Society of Anesthesiologists (ASA) grades I–III patients with age 18–75 years undergoing lower limb orthopedic surgery were prospectively recruited into APS (index group) or routine postoperative care (control group) (n = 55 each). Postoperatively, American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and Short Form (SF-12) were used to evaluate the outcome of postoperative pain management at 24 h and health-related quality of life after 4 weeks respectively. Results: Both groups were comparable in terms of demographic data. Patients in the index group had statistically significant better perception of care than the control group. Index group scored significantly higher than control group on median patient satisfaction score (9; interquartile range [IQR] [7–10] vs. 5 [3–6]; P < 0.001). In index group, there was significant reduction of worst pain in first 24 h along with decreased frequency of severe pain. Conclusion: Implementation of acute pain service plays an important role in improving the quality of postoperative pain relief, perception of care, and patient satisfaction.
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Affiliation(s)
- Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Kompal Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Swati Jindal
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Manpreet Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jannat Kang
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sudhir Garg
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Wooldridge S, Branney J. Congruence between nurses' and patients' assessment of postoperative pain: a literature review. ACTA ACUST UNITED AC 2020; 29:212-220. [DOI: 10.12968/bjon.2020.29.4.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.
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Affiliation(s)
- Sarah Wooldridge
- Student Nurse, Department of Nursing Science, Bournemouth University
| | - Jonathan Branney
- Senior Lecturer in Adult Nursing, Department of Nursing Science, Bournemouth University
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Stamer UM, Liguori GA, Rawal N. Thirty-five Years of Acute Pain Services: Where Do We Go From Here? Anesth Analg 2020; 131:650-656. [DOI: 10.1213/ane.0000000000004655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Epstein D, Steinfeld Y, Marcusohn E, Ammouri H, Miller A. Health care professionals’ knowledge of commonly used sedative, analgesic and neuromuscular drugs: A single center (Rambam Health Care Campus), prospective, observational survey. PLoS One 2020; 15:e0227499. [PMID: 31923236 PMCID: PMC6953819 DOI: 10.1371/journal.pone.0227499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
- * E-mail:
| | - Yaniv Steinfeld
- Orthopedic Surgery Division, Rambam Health Care Campus, Haifa, Israel
| | - Erez Marcusohn
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Hanna Ammouri
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Asaf Miller
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
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Small C, Laycock H. Acute postoperative pain management. Br J Surg 2020; 107:e70-e80. [DOI: 10.1002/bjs.11477] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 12/16/2022]
Abstract
AbstractBackgroundAcute postoperative pain is common. Nearly 20 per cent of patients experience severe pain in the first 24 h after surgery, a figure that has remained largely unchanged in the past 30 years. This review aims to present key considerations for postoperative pain management.MethodsA narrative review of postoperative pain strategies was undertaken. Searches of the Cochrane Library, PubMed and Google Scholar databases were performed using the terms postoperative care, psychological factor, pain management, acute pain service, analgesia, acute pain and pain assessment.ResultsInformation on service provision, preoperative planning, pain assessment, and pharmacological and non-pharmacological strategies relevant to acute postoperative pain management in adults is presented, with a focus on enhanced recovery after surgery pathways.ConclusionAdequate perioperative pain management is integral to patient care and outcomes. Each of the biological, psychological and social dimensions of the pain experience should be considered and understood in order to provide optimum pain management in the postoperative setting.
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Affiliation(s)
- C Small
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Laycock
- Department of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
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Meissner W, Zaslansky R. A survey of postoperative pain treatments and unmet needs. Best Pract Res Clin Anaesthesiol 2019; 33:269-286. [PMID: 31785713 DOI: 10.1016/j.bpa.2019.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
More than 300 million patients undergo surgery worldwide each year. Pain associated with these procedures is associated with short- and long-term negative sequelae for patients, healthcare providers, and healthcare systems. The following chapter is a review of the reality of postoperative pain management in everyday clinical routine based on survey- and registry-derived data with a focus on care in adults. Between 30% and up to 80% of patients report moderate to severe pain in the days after surgery. Structures, processes, and outcomes vary widely between hospitals and indicate gaps between evidence-based findings and practice. Pain assessment is not effectively implemented in many hospitals and should consider cultural differences. Few data exist on the situation of pain management in low- and middle-income countries, indicating lack of resources and available medication in many of these areas. Certain types of surgery as well as demographic and clinical factors are associated with increased risk of severe postoperative pain.
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Affiliation(s)
- Winfried Meissner
- Dept of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07740 Jena, Germany.
| | - Ruth Zaslansky
- Dept of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07740 Jena, Germany
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