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Beetsma AJ, Paap D, Pool G, Reezigt RR, de Ruiter E, Hobbelen HSM, Reneman MF. Meaningful contributions of rehabilitation for people with persistent pain; a reflexive thematic analysis. Disabil Rehabil 2024:1-12. [PMID: 39028272 DOI: 10.1080/09638288.2024.2367602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/09/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain. MATERIALS AND METHODS A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses. RESULTS Participants included three men and ten women, age ranging from 22-69 years, pain duration was 2-30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants' perspective. CONCLUSIONS The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.
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Affiliation(s)
- Anneke J Beetsma
- Department of Health Care Studies, School for Physiotherapy, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Davy Paap
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Physical Therapy, Saxion University of Applied Science, Enschede, Netherlands
| | - Grieteke Pool
- Department of Health Psychology, Faculty of Medical Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Roland R Reezigt
- Department of Health Care Studies, School for Physiotherapy, Hanze University of Applied Sciences, Groningen, The Netherlands
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eugenie de Ruiter
- First Line Health Centers, Wormerveer, Haarlem, The Netherlands
- Rehabilitation Center Heliomare, Wijkaan Zee, The Netherlands
| | - Hans S M Hobbelen
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of General Practice and Elderly Care Medicine University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- FAITH Research, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Nunes JC, Costa GPA, Weleff J, Rogan M, Compton P, De Aquino JP. Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations. Br J Clin Pharmacol 2024. [PMID: 38556851 DOI: 10.1111/bcp.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.
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Affiliation(s)
- Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Rogan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Connecticut, USA
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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Kaseweter K, Nazemi M, Gregoire N, Louw WF, Walsh Z, Holtzman S. Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era. BMC Health Serv Res 2023; 23:1131. [PMID: 37864210 PMCID: PMC10588239 DOI: 10.1186/s12913-023-10157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians' current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation. METHODS A total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey. RESULTS The sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options. CONCLUSIONS Findings provide insight into physicians' ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.
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Affiliation(s)
- Kimberley Kaseweter
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Mark Nazemi
- Clinical and Wellbeing Solutions, Thrive Health Inc, 200 - 116 West Hastings Street, Vancouver, BC, V6B 1G8, Canada
| | - Nina Gregoire
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - W Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Bill Nelems Pain and Research Centre, 309-2755 Tutt St, Kelowna, BC, V1Y 0G1, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
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Sun A, Holmes R, Greenberg I, Reilly JM. Implementation of an online and in-person addiction medicine course and its impact on medical students' knowledge on substance use disorders. J Addict Dis 2023; 41:282-288. [PMID: 35984376 DOI: 10.1080/10550887.2022.2109922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Substance use is a public health crisis that requires improved education on substance use disorders (SUDs) in medical school curriculum to ensure that the future generation of physicians is prepared to care for this growing patient population. OBJECTIVES This study evaluates how the implementation of an online and in-person addiction medicine course impacted medical students' knowledge on SUD and caring for patients with SUD. METHODS 86 third-year and fourth-year medical students participated in either an online or in-person elective course on addiction medicine. Students learned about SUDs through various modalities, such as online SUD modules, clinical encounters, movies, books, participation in support group meetings and learning evidence-based tools to screen or treat patients. To assess the impact of the course curriculum on students' knowledge in treating SUDs, a pre and post survey was administered and analyzed. RESULTS After completing the SUD course, students showed significant improvement (P < 0.01) in caring for SUD patients. Specifically, they improved in the areas of: assessing a patient with SUD, comfort and knowledge in using motivational interviewing to affect behavior change in a patient with a SUD, and knowledge of community resources related to SUD. Students also showed a significant improvement (P < 0.01) in the number of unique SUDs (such as opioids or alcohol) they felt knowledgeable about and in the number of treatment modalities for unique SUDs. CONCLUSIONS Implementation of an addiction medicine course that utilizes various teaching modalities can significantly improve medical students' fundamental knowledge on SUD.
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Affiliation(s)
- Alexander Sun
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Randolph Holmes
- PIH Health Whittier Hospital, Whittier, CA, USA
- Los Angeles Center for Alcohol and Drug Abuse, Santa Fe Springs, CA, USA
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Hudon A, Augeard N, Tansey CM, Houston E, Bostick G, Wideman TH. Does feeling pain help prepare future clinicians to treat pain? A qualitative exploration of a novel experiential approach to teaching health professional students about pain. Physiother Theory Pract 2023:1-13. [PMID: 37682624 DOI: 10.1080/09593985.2023.2254367] [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: 12/20/2022] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND INTRODUCTION Pain is a subjective phenomenon, that is often misunderstood and invalidated. Despite recent advances in health professional training, it remains unclear how students should be taught about the subjectivity of pain. This study explored how a novel teaching activity that integrated physiotherapy students' first-hand experiences with laboratory-induced pain could address this gap. OBJECTIVE The study aimed to explore the experiences and perceptions of physiotherapy students in relation to a workshop where physiotherapy students experienced laboratory induced pain. METHODS We used a descriptive qualitative research design. Eighteen students participated in interviews. Transcripts were analyzed using an inductive conventional content analysis. RESULTS We identified four overarching themes: 1) First-hand pain experiences facilitated engagement in learning; 2) Reflecting on these personal and peer pain experiences helped students make sense of pain; 3) The learning activity helped students understand the inherent subjectivity and complexity of pain; and 4) Students saw benefits for clinical practice. CONCLUSION Integrating first-hand pain experiences within entry-level physiotherapy training appears to have novel value in helping students understand pain subjectivity. Future research should use robust and controlled designs to explore how this novel approach can be used to facilitate further understanding and empathy within clinical interactions with people living with pain.
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Affiliation(s)
- Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest de l'Ile-de-Montréal (CIUSSS COMTL) Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
| | - Nathan Augeard
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Catherine M Tansey
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Emilie Houston
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy H Wideman
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest de l'Ile-de-Montréal (CIUSSS COMTL) Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Mardian AS, Villarroel L, Quist HE, Chang LE, Mintert JS, Su TN, Dhanjal-Reddy A, Hanson ER. Flipping the hidden curriculum to transform pain education and culture. FRONTIERS IN PAIN RESEARCH 2023; 4:1197374. [PMID: 37404692 PMCID: PMC10317194 DOI: 10.3389/fpain.2023.1197374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Though long-sought, transformation of pain management practice and culture has yet to be realized. We propose both a likely cause-entrenchment in a biomedical model of care that is observed and then replicated by trainees-and a solution: deliberately leveraging the hidden curriculum to instead implement a sociopsychobiological (SPB) model of care. We make use of Implicit Bias Recognition and Management, a tool that helps teams to first recognize and "surface" whatever is implicit and to subsequently intervene to change whatever is found to be lacking. We describe how a practice might use iterations of recognition and intervention to move from a biomedical to a SPB model by providing examples from the Chronic Pain Wellness Center in the Phoenix Veterans Affairs Health Care System. As pain management practitioners and educators collectively leverage the hidden curriculum to provide care in the SPB model, we will not only positively transform our individual practices but also pain management as a whole.
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Affiliation(s)
- Aram S. Mardian
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Lisa Villarroel
- Arizona Department of Health Services, Public Health Services, Phoenix, AZ, United States
| | - Heidi E. Quist
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Lynn E. Chang
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Jeffrey S. Mintert
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Tiffany N. Su
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Amrita Dhanjal-Reddy
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Eric R. Hanson
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
- Department of Psychiatry, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
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Miró J, Solé E, Castarlenas E, Ingelmo P, Nolla MDC, Escribano J, Reinoso-Barbero F. The Treatment of Pediatric Pain in Spain: A Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2484. [PMID: 36767850 PMCID: PMC9915536 DOI: 10.3390/ijerph20032484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional needs as perceived by healthcare professionals. A total of 277 healthcare professionals took part, all of whom had wide experience in managing children and adolescents with pain (M [SD] age = 44.85, [10.73]; 75% women). Participants had to respond to a web-based survey with 50 questions related to pain education, organizational characteristics of their pain programs (including the characteristics of the patients treated), and current practices in the assessment and treatment of children and adolescents with pain. Almost all the participants (93%) acknowledged important gaps in their training, and only 47% reported that they had received specific education on the management of pediatric pain during their undergraduate and postgraduate studies. A third (31%) were members of multidisciplinary teams, and almost all (99%) understood that protocols to guide the management of pain in young people were necessary. However, only a few of them used a protocol to assess and treat (56% and 48%, respectively) acute and chronic pain (24% and 23%, respectively). The data also showed that a lack of pain education, coordination of professionals, and guidelines was perceived as an important barrier in the care provided to children and adolescents with pain in Spain. The findings of this study can now be used by healthcare professionals in Spain interested in managing pediatric pain, as well as policymakers concerned to improve the education of professionals and the care given to young people with pain.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University, 1001 Boul. Decarie, Montreal, QC H4A 3J1, Canada
| | - Maria del Carme Nolla
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
- Xarxa Social i Sanitària, 43003 Tarragona, Spain
| | - Joaquín Escribano
- School of Medicine, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain
- Department of Pediatrics, Hospital Universitari Sant Joan, Avgda. Dr. Josep Laporte 2, 43204 Reus, Spain
| | - Francisco Reinoso-Barbero
- Pediatric Anesthesiology Service, Hospital Universitario La Paz, P. Castellana 261, 28046 Madrid, Spain
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Shipton E, Steketee C, Visser E. The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum. FRONTIERS IN PAIN RESEARCH 2023; 3:1057114. [PMID: 36700142 PMCID: PMC9869177 DOI: 10.3389/fpain.2022.1057114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023] Open
Abstract
Medical practitioners play an essential role in preventing pain, conducting comprehensive pain assessments, as well as promoting evidence-based practices. There is a need for the development of innovative, interprofessional and integrated pain medicine curricula for medical students. The Pain Medicine Curriculum Framework (PMCF) was developed to conceptualise a purposeful approach to the complex process of curriculum change and to prioritise the actions needed to address the gaps in pain medicine education. The PMCF comprises four dimensions: (1) future healthcare practice needs; (2) competencies and capabilities required of graduates; (3) teaching, learning and assessment methods; and (4) institutional parameters. Curricula need to meet the requirements of registration and accreditation bodies, but also equip graduates to serve in their particular local health system while maintaining the fundamental standards and values of these institutions. The curriculum needs to connect knowledge with experience and practice to be responsive to the changing needs of the increasingly complex health system yet adaptable to patients with pain in the local context. Appropriate learning, teaching and assessment strategies are necessary to ensure that medical practitioners of the future develop the required knowledge, skills and attitudes to treat the diverse needs of patients' experiencing pain. The historical, political, social and organisational values of the educational institution will have a significant impact on curriculum design. A more formalised approach to the development and delivery of a comprehensive pain medicine curriculum is necessary to ensure that medical students are adequately prepared for their future workplace responsibilities.
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Affiliation(s)
- Elspeth Shipton
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Carole Steketee
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Eric Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
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Mukhida K, Sedighi S, Hart C. "Give My Daughter the Shot!": A Content Analysis of the Depiction of Patients with Cancer Pain and Their Management in Hollywood Films. Curr Oncol 2022; 29:8207-8221. [PMID: 36354708 PMCID: PMC9689053 DOI: 10.3390/curroncol29110648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Cinemeducation, the pedagogical use of films, has been used in a variety of clinical disciplines. To date, no studies have looked at the use of film depictions of cancer pain and its management in clinical education. We investigated how patients with cancer pain and their management are depicted in Hollywood films to determine whether there is content that would be amenable to use for cancer pain assessment and management education. METHODS A qualitative content analysis was performed. Films that contained characters with or references to cancer pain were searched for using the International Movie Database, the Literature Arts Medicine Database, the History of Medicine and Medical Humanities Database, and Medicine on Screen. After review, 4 films were identified for review and analysis. RESULTS Themes that emerged from the analysis concerned the films' depictions of characters with pain, their healthcare providers, the therapies used for pain management, and the setting in which pain management was provided. CONCLUSIONS This study demonstrates that patients with cancer pain are depicted in a compassionate manner. Pain management focused on the use of opioids. The settings in which patients received pain management was depicted as not being amenable to providing holistic care. This variety of topics related to pain management covered in the films make them amenable to use in cinemeducation. This study therefore forms the basis for future work developing film-based cancer education modules.
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Affiliation(s)
- Karim Mukhida
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Correspondence:
| | - Sina Sedighi
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Mirman B, Mukhdomi TJ, Rajaguru P, Whitten I, Fragoza K, Siddiqui A, Carayannopoulos A, Kendall MC. Pain education during the coronavirus pandemic: the introduction of pain medicine during the pre-clinical years. PAIN MEDICINE 2022; 23:609-613. [PMID: 35022772 PMCID: PMC9383209 DOI: 10.1093/pm/pnac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 12/11/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Benjamin Mirman
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States 02903
| | - Taif J Mukhdomi
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island., United States 02903
| | - Praveen Rajaguru
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States 02903
| | - Ira Whitten
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island., United States 02903
| | - Keith Fragoza
- Department of Anesthesiology & Pain Medicine, Providence VAMC/Brown University, Providence, Rhode Island, United States 02903
| | - Afreen Siddiqui
- Department of Anesthesiology & Pain Medicine, Providence VAMC/Brown University, Providence, Rhode Island, United States 02903
| | - Alexios Carayannopoulos
- Department of Physical Medicine & Rehabilitation, Brown University, Providence, Rhode Island, United States 02903
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island., United States 02903
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Thompson K, Johnson MI, Milligan J, Briggs M. Rethinking pain education from the perspectives of people experiencing pain: a meta-ethnography to inform physiotherapy training. BMJ Open 2022; 12:e046363. [PMID: 35017228 PMCID: PMC8753399 DOI: 10.1136/bmjopen-2020-046363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned.Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training. METHODS Noblit and Hare's seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript. RESULTS A total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients' needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a 'needs-based' model to inform pre-registration physiotherapy training. DISCUSSION The findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy.
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Affiliation(s)
- Kate Thompson
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Mark I Johnson
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - James Milligan
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery & Social Work, Manchester University NHS Foundation Trust, Manchester, UK
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13
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Mankelow J, Ryan CG, Morris H, Lauchlan D, Seenan C, Taylor P, Martin D. Charting physiotherapy students' attitudes toward people with chronic pain as they progress through their undergraduate programme: An observational study. Physiother Theory Pract 2021; 38:2658-2664. [PMID: 34496724 DOI: 10.1080/09593985.2021.1976890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare professionals' attitudes toward people with chronic pain influence their clinical practice. OBJECTIVES To investigate physiotherapy students' attitudes and beliefs toward people with chronic pain over the course of their Scottish undergraduate program. METHODS In this observational study, physiotherapy students from one university were recruited in the first year and followed up to their final year (year 1 n = 62/75, year 2 n = 68/72, year 3 n = 59/69, year 4 n = 74/74) for 4 years. The Health-Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15 to 105) was completed annually. RESULTS A one-way ANOVA found that attitudes and beliefs improved significantly (p < .01) from the first to final year (9.2 ± 11.5 (mean±SD)). Participants showed a reduction in scores (signifying improved attitudes) annually with smaller reductions initially followed by a larger reduction in the final 2 years. CONCLUSIONS This is the first study to chart changes in the same cohort of physiotherapy students' attitudes and beliefs toward people with chronic pain over time. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs toward people with chronic pain so that courses can be enhanced accordingly.
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Affiliation(s)
- Jagjit Mankelow
- School of Health and Social Care, Centuria Building,Teesside University, UK
| | - Cormac G Ryan
- School of Health and Social Care, Centuria Building,Teesside University, UK
| | - Hayley Morris
- Institute of Cancer Sciences, University of Glasgow, Bearsden, Scotland
| | - Douglas Lauchlan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Paul Taylor
- School of Health and Social Care, Centuria Building,Teesside University, UK
| | - Denis Martin
- School of Health and Social Care, Centuria Building,Teesside University, UK
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14
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Lee RR, McDonagh JE, Connelly M, Peters S, Cordingley L. Identifying the content and context of pain within paediatric rheumatology healthcare professional curricula in the UK: a summative content analysis. Pediatr Rheumatol Online J 2021; 19:129. [PMID: 34419095 PMCID: PMC8379855 DOI: 10.1186/s12969-021-00614-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality. METHODS Core curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore the context within which pain terms were positioned. RESULTS Nine curriculum documents were identified and analysed from doctors, nurses, physiotherapists and occupational therapists specialising in paediatric rheumatology. Pain themes represented a mean percentage of 1.51% of text across all documents. Pain was rarely presented in the context of both inflammatory and non-inflammatory condition types despite being a common feature of each. Musculoskeletal pain was portrayed simply as a 'somatic' symptom, rather than as a complex phenomenon involving biological and psychosocial processes. Content around the assessment and management of pain was vague and inexplicit. CONCLUSION Current educational and training documentation in paediatric rheumatology do not include core pain topics. Curricula for these healthcare professionals would benefit from updates in contemporary pain theories and examples of in-context, evidence-based pain practices. This should be a priority starting point for optimising patient pain care in paediatric musculoskeletal healthcare.
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Affiliation(s)
- Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- Royal Manchester Children's Hospital, Manchester University Foundation Hospitals Trust, Manchester, UK
| | - Mark Connelly
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, USA
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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15
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Onyeka TC, Iloanusi N, Namisango E, Onu JU, Okunade KS, Mohammed AD, Gadanya MA, Nagoma AU, Ojiakor S, Ilo C, Okuzu O, Oduche C, Ugwu N, Allsop MJ. Project OPUS: Development and evaluation of an electronic platform for pain management education of medical undergraduates in resource-limited settings. PLoS One 2020; 15:e0243573. [PMID: 33301477 PMCID: PMC7728241 DOI: 10.1371/journal.pone.0243573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Pain is a very frequent symptom that is reported by patients when they present to health professionals but remains undertreated or untreated, particularly in low-resource settings including Nigeria. Lack of training in pain management remains the most significant obstacle to pain treatment alongside an inadequate emphasis on pain education in undergraduate medical curricula, negatively impacting on subsequent care of patients. This study aimed to determine the effect of a 12-week structured e-Learning course on the knowledge of pain management among Nigerian undergraduate medical students. METHODS Prospective, multisite, pre-post study conducted across five medical colleges in Nigeria. Structured modules covering aspects of pain management were delivered on an e-Learning platform. Pre- and post-test self-assessments were carried out in the 12-week duration of the study. User experience questionnaires and qualitative interviews were conducted via instant messaging to evaluate user experiences of the platform. User experience data was analysed using the UEQ Data Analysis Tool and Framework Analysis. RESULTS A total of 216 of 659 eligible students completed all sections of the e-Learning course. Participant mean age was 23.52 years, with a slight female predominance (55.3%). Across all participants, an increase in median pre- and post-test scores occurred, from 40 to 60 (Z = 11.3, p<0.001, effect size = 1.3), suggestive of increased knowledge acquisition relating to pain management. Participants suggested e-Learning is a valuable approach to delivering pain education alongside identifying factors to address in future iterations. CONCLUSION e-Learning approaches to pain management education can enhance traditional learning methods and may increase students' knowledge. Future iterations of e-Learning approaches will need to consider facilitating the download of data and content for the platform to increase user uptake and engagement. The platform was piloted as an optional adjunct to existing curricula. Future efforts to advocate and support integration of e-Learning for pain education should be two-fold; both to include pain education in the curricula of medical colleges across Nigeria and the use of e-Learning approaches to enhance teaching where feasible.
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Affiliation(s)
- Tonia C. Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
- EPAC Research Team, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Nneka Iloanusi
- EPAC Research Team, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
- Department of Radiation Medicine, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Justus U. Onu
- EPAC Research Team, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Enugu State, Nigeria
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Kehinde S. Okunade
- Oncology and Pathological Studies (OPS) Unit, Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria
| | - Alhassan Datti Mohammed
- Department of Anaesthesia, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Muktar A. Gadanya
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Abubakar U. Nagoma
- Department of Anaesthesia, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Samuel Ojiakor
- Department of Anaesthesia, College of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chukwudi Ilo
- College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
| | - Okey Okuzu
- InStrat Global Health Solutions, Abuja, Nigeria
| | | | - Ngozi Ugwu
- Department of Haematology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Matthew J. Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Lechowicz K, Karolak I, Drożdżal S, Żukowski M, Szylińska A, Białecka M, Rotter I, Kotfis K. Acute and Chronic Pain Learning and Teaching in Medical School-An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students. ACTA ACUST UNITED AC 2019; 55:medicina55090533. [PMID: 31454932 PMCID: PMC6780207 DOI: 10.3390/medicina55090533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 01/26/2023]
Abstract
Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.
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Affiliation(s)
- Kacper Lechowicz
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Igor Karolak
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sylwester Drożdżal
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Maciej Żukowski
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland.
| | - Monika Białecka
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
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Garcia JBS, Neto JOB, Rodrigues TA. The role of academic leagues as a strategy for pain education in Brazil. J Pain Res 2019; 12:1891-1898. [PMID: 31417301 PMCID: PMC6592053 DOI: 10.2147/jpr.s205481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/31/2019] [Indexed: 01/24/2023] Open
Abstract
Purpose Chronic pain remains undertreated in both developed and developing countries. There are various factors involved in this acknowledged health problem, including lack of pain education. In Brazil, a particular approach was used to mitigate the deficit in pain education. The academic leagues of pain (ALPs) were formed as associations of health undergraduate students with the goal of encouraging students in educational activities, patient care, and pain research. The aim of this study was to evaluate how ALP works and its contribution to pain education and to the inclusion of students in practical and scientific research activities, as well as its legacy in the field of pain. Patients and methods An electronic survey was directed to the leagues representatives to collect data referent to how the leagues operate, their individual approach towards pain education, patient care, research activities, and its impact on students after they graduate. Results A total of 17 leagues were identified and responded to the survey. Only three of the involved universities offered study of pain as a discipline in their mandatory curriculum. Patient care activities were carried out by 59% of the leagues, 94% provided educational activities. Twelve leagues reported that students were involved in one to four research projects in pain, and 59% of those chose pain as their subject for post-graduation programs. And, 47% of the leagues had students that sought specialization or residency in pain after graduation. Conclusion The Brazilian experience with academic leagues of pain has shown that it is possible to address curricular deficiencies in pain education through a strategy not well known in other countries.
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Affiliation(s)
- João Batista Santos Garcia
- Experimental Laboratory to the Study of Pain, Federal University of Maranhão, São Luis, Maranhão, Brazil
| | - José Osvaldo Barbosa Neto
- Experimental Laboratory to the Study of Pain, Federal University of Maranhão, São Luis, Maranhão, Brazil
| | - Thiago Alves Rodrigues
- Experimental Laboratory to the Study of Pain, Federal University of Maranhão, São Luis, Maranhão, Brazil
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18
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Exploring assessment of medical students' competencies in pain medicine-A review. Pain Rep 2018; 4:e704. [PMID: 30801044 PMCID: PMC6370140 DOI: 10.1097/pr9.0000000000000704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education. Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students. Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December 2016. Results: A total of 41 studies met the inclusion criteria. Most assessments were performed for low-stakes summative purposes and did not reflect contemporary theories of assessment. Assessments were predominantly undertaken using written tests or clinical simulation methods. The most common pain medicine education topics assessed were pain pharmacology and the management of cancer and low-back pain. Most studies focussed on assessment of cognitive levels of learning as opposed to more challenging domains of demonstrating skills and attitudes or developing and implementing pain management plans. Conclusion: This review highlights the need for more robust assessment tools that effectively measure the abilities of medical students to integrate pain-related competencies into clinical practice. A Pain Medicine Assessment Framework has been developed to encourage systematic planning of pain medicine assessment at medical schools internationally and to promote continuous multidimensional assessments in a variety of clinical contexts based on well-defined pain medicine competencies.
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Tawil S, Iskandar K, Salameh P. Pain management in hospitals: patients' satisfaction and related barriers. Pharm Pract (Granada) 2018; 16:1268. [PMID: 30416629 PMCID: PMC6207353 DOI: 10.18549/pharmpract.2018.03.1268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/01/2018] [Indexed: 02/03/2023] Open
Abstract
Background: Suboptimal pain control has been frequently reported in healthcare settings and documented to negatively impact patients’ health. Patients’ perception regarding pain management may influence their satisfaction regarding treatment. Objectives: This study focuses on the assessment of patients’ satisfaction regarding pain therapy and defining patient-related barriers for its implication. Methods: A cross-sectional study was conducted in two tertiary care hospitals from April till July 2017. A face-to face interview questionnaire was filled regarding pain scores and patients’ attitudes regarding pain management. Both medical and post-surgical adult patients with all types of pain were eligible to participate. A descriptive analysis of patient satisfaction and perceptions regarding pain management was done. Results: Results from 183 participants with a mean age of 49 (SD=17.33) revealed that pain was their main reason for hospitalization (71.6% of the cases). Numeric pain scores were recorded only in 14.2% of the patient medical files. Pain intensity documentation by healthcare professionals was found in 41.5% of the cases, and 7.7% of the patients had to wait for more than 30 minutes before getting the pain medication. Around 85% of the patients were satisfied with their pain management. Patients’ barriers to effective pain therapy were mainly fear of adverse effects, addiction, and additional costs (p<0.05). Conclusions: Pain remains a prevalent problem that requires more efforts for improvement. Our study can effectively serve as a start for larger studies where barriers to pain management can be assessed as an independent variable affecting pain management practice.
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Affiliation(s)
- Samah Tawil
- Drug Information Center & Continuing Education Department, Lebanese Order of Pharmacists. Beirut (Lebanon).
| | - Katia Iskandar
- Continuing Education Department. Lebanese Order of Pharmacists; & INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University. Beirut (Lebanon).
| | - Pascale Salameh
- Continuing Education Department. Lebanese Order of Pharmacists; & INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University. Beirut (Lebanon).
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20
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Kim B, Nolan S, Ti L. Addressing the prescription opioid crisis: Potential for hospital-based interventions? Drug Alcohol Rev 2018; 36:149-152. [PMID: 28326630 DOI: 10.1111/dar.12541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/12/2017] [Accepted: 02/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Brian Kim
- Department of Medicine, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Seonaid Nolan
- Department of Medicine, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Lianping Ti
- Department of Medicine, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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21
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Tran UE, Kircher J, Jaggi P, Lai H, Hillier T, Ali S. Medical students' perspectives of their clinical comfort and curriculum for acute pain management. J Pain Res 2018; 11:1479-1488. [PMID: 30122978 PMCID: PMC6080666 DOI: 10.2147/jpr.s159422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Acute pain is a common presenting complaint in health care. Yet, undertreatment of pain remains a prevailing issue that often results in poor short- and long-term patient outcomes. To address this problem, initiatives to improve teaching on pain management need to begin in medical school. In this study, we aimed to describe medical students' perspectives of their curriculum, comfort levels, and most effective pain teaching modalities. Materials and methods A cross-sectional, online survey was distributed to medical students at the University of Alberta (Edmonton, Canada) from late May to early July 2015. Data were collected from pre-clerkship (year 1 and 2) and clerkship (year 3 and 4) medical students for demographic characteristics, knowledge, comfort, and attitudes regarding acute pain management. Results A total of 124/670 (19.6%) surveys were returned. Students recalled a median of 2 (interquartile range [IQR]=4), 5 (IQR=3.75), 4 (IQR=8), and 3 (IQR=3.75) hours of formal pain education from first to forth year, respectively. Clerkship students were more comfortable than pre-clerks with treating adult pain (52.1% of pre-clerks "uncomfortable" versus 22.9% of clerks, p<0.001), and overall, the majority of students were uncomfortable with managing pediatric pain (87.6% [64/73] pre-clerks and 75.0% [36/48] clerks were "uncomfortable"). For delivery of pain-related education, the majority of pre-clerks reported lectures as most effective (51.7%), whereas clerks chose bedside instruction (43.7%) and small group sessions (23.9%). Notably, 54.2%, 39.6%, and 56.2% of clerks reported incorrect doses of acetaminophen, ibuprofen, and morphine, respectively, for adults. For children, 54.2%, 54.2%, and 78.7% of clerks reported incorrect doses for these same medications. Conclusion Medical students recall few hours of training in pain management and report discomfort in treating and assessing both adult and (more so) pediatric pain. Strategies are needed to improve education for future physicians regarding pain management.
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Affiliation(s)
- Uyen Evelyn Tran
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Janeva Kircher
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,
| | - Priya Jaggi
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tracey Hillier
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, .,Women and Children's Health Research Institute, Edmonton, Alberta, Canada,
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22
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Twenty-five years of pain education research—what have we learned? Findings from a comprehensive scoping review of research into pre-registration pain education for health professionals. Pain 2018; 159:2146-2158. [DOI: 10.1097/j.pain.0000000000001352] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Toye F, Seers K, Barker K. A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundPeople with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.Objectives(1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs.DesignWe used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument.Data sourcesWe searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings.ResultsWe screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (seeReport Supplementary Material 1; URL:www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy.LimitationsThere are no agreed methods for determining confidence in QESs.ConclusionsWe highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain.Future workFuture work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Toye F, Seers K, Barker KL. Meta-ethnography to understand healthcare professionals' experience of treating adults with chronic non-malignant pain. BMJ Open 2017; 7:e018411. [PMID: 29273663 PMCID: PMC5778293 DOI: 10.1136/bmjopen-2017-018411] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We aimed to explore healthcare professionals' experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care. DESIGN Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals' experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings. RESULTS We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high. CONCLUSIONS This is the first qualitative evidence synthesis of healthcare professionals' experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Comer L. Content analysis of chronic pain content at three undergraduate medical schools in Ontario. Can J Pain 2017; 1:75-83. [PMID: 35005343 PMCID: PMC8730565 DOI: 10.1080/24740527.2017.1337467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/23/2017] [Accepted: 05/30/2017] [Indexed: 11/02/2022]
Abstract
Background: It has been well documented that interdisciplinary, comprehensive pain education can foster positive pain beliefs among medical students, in addition to improving students' abilities to diagnose and treat pain. Though some work has been done to quantify the number of hours of pain education students receive, the content itself has received little attention. Aims: This study seeks to identify what medical students learn about chronic pain throughout an undergraduate medical degree program in Ontario. Methods: Three undergraduate medical schools in Ontario were selected on the basis of variety in curricular structure and instructional methods. Written documents comprising the formal curriculum were analyzed through qualitative and quantitative content analysis. These findings were compared with promising practices from the pain education literature. Results: The three curricula studied here dedicate the bulk of pain education to three topics: pain mechanisms, pain management, and opioids and addiction. The curricula vary considerably in organization of content and hours of pain training. All three curricula were found to contain negative pain beliefs that characterize pain patients as difficult, overwhelming, and unrewarding to work with. Two of the medical schools studied here do not have a pain curriculum. Conclusions: The results of this study indicate a need for medical schools to develop comprehensive, interdisciplinary pain curricula. Though increasing the number of hours of pain training is crucial, equally imperative is a consideration of what, and how, students learn about pain.
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Schoneboom BA, Perry SM, Barnhill WK, Giordano NA, Wiltse Nicely KL, Polomano RC. Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health. Nurs Outlook 2016; 64:459-84. [DOI: 10.1016/j.outlook.2016.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
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Carr EC, Watt-Watson J, McGillion M, Huizinga A. The quest of pain education leaders in Canada and the United States: a qualitative study. J Adv Nurs 2016; 72:2728-2737. [DOI: 10.1111/jan.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Judy Watt-Watson
- Faculty of Nursing (Lawrence S. Bloomberg); University of Toronto; Ontario Canada
| | - Michael McGillion
- Heart and Stroke Foundation/Michael G. DeGroote Chair in Cardiovascular Nursing; School of Nursing; McMaster University; Hamilton Ontario Canada
| | - Anne Huizinga
- Faculty of Nursing; University of Calgary; Alberta Canada
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Physicians' Attitudes to Clinical Pain Management and Education: Survey from a Middle Eastern Country. Pain Res Manag 2016; 2016:1358593. [PMID: 27445596 PMCID: PMC4904623 DOI: 10.1155/2016/1358593] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/31/2015] [Indexed: 11/18/2022]
Abstract
Despite promising initiatives to advance the practice of pain management in Middle Eastern countries, their pain care lags behind developed countries. The objectives of this study are to evaluate physicians' assessment of their own competency in pain management, to assess physicians' practice related to pain management, and to identify physician-related barriers to effective pain control. A cross-sectional survey was conducted in 3 teaching medical centers in Lebanon targeting the above-mentioned outcomes and assessing the impact of physicians' years in practice on the studied end-points. A total of 69 physicians were surveyed. Fifty-seven percent reported "very good to excellent" pain management skills; only 25% of them described the need for continuing professional development. When treating patients with pain, 52% of physicians refer to updated international guidelines, whereas 43% rely on their own judgment. Physicians were more likely to consult with another physician (65%) rather than a pharmacist (12%) when treating patients with pain. Fear of adverse effects of analgesics was the most commonly reported barrier (45%) to pain control among physicians from different career stages. Based on these survey findings, national pain management and practice policies are needed to optimize this area of deficiency in patient care.
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