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Darville-Beneby R, Lomanowska AM, Yu HC, Jobin P, Rosenbloom BN, Gabriel G, Daudt H, Negraeff M, Di Renna T, Hudspith M, Clarke H. The Impact of Preoperative Patient Education on Postoperative Pain, Opioid Use, and Psychological Outcomes: A Narrative Review. Can J Pain 2023; 7:2266751. [PMID: 38126044 PMCID: PMC10732618 DOI: 10.1080/24740527.2023.2266751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/30/2023] [Indexed: 12/23/2023]
Abstract
Background Recent studies have shown that preoperative education can positively impact postoperative recovery, improving postoperative pain management and patient satisfaction. Gaps in preoperative education regarding postoperative pain and opioid use may lead to increased patient anxiety and persistent postoperative opioid use. Objectives The objective of this narrative review was to identify, examine, and summarize the available evidence on the use and effectiveness of preoperative educational interventions with respect to postoperative outcomes. Method The current narrative review focused on studies that assessed the impact of preoperative educational interventions on postoperative pain, opioid use, and psychological outcomes. The search strategy used concept blocks including "preoperative" AND "patient education" AND "elective surgery," limited to the English language, humans, and adults, using the MEDLINE ALL database. Studies reporting on preoperative educational interventions that included postoperative outcomes were included. Studies reporting on enhanced recovery after surgery protocols were excluded. Results From a total of 761 retrieved articles, 721 were screened in full and 34 met criteria for inclusion. Of 12 studies that assessed the impact of preoperative educational interventions on postoperative pain, 5 reported a benefit for pain reduction. Eight studies examined postoperative opioid use, and all found a significant reduction in opioid consumption after preoperative education. Twenty-four studies reported on postoperative psychological outcomes, and 20 of these showed benefits of preoperative education, especially on postoperative anxiety. Conclusion Preoperative patient education interventions demonstrate promise for improving postoperative outcomes. Preoperative education programs should become a prerequisite and an available resource for all patients undergoing elective surgery.
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Affiliation(s)
- Rasheeda Darville-Beneby
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
| | - Anna M. Lomanowska
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
| | - Hai Chuan Yu
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Parker Jobin
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Brittany N. Rosenbloom
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gretchen Gabriel
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
| | - Helena Daudt
- Pain BC/Pain Canada, Vancouver, British Columbia, Canada
| | - Michael Negraeff
- Pain BC/Pain Canada, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tania Di Renna
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Academic Pain Medicine Institute, Toronto, Ontario, Canada
| | - Maria Hudspith
- Pain BC/Pain Canada, Vancouver, British Columbia, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
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Fender Z, Bleicher J, Johnson JE, Phan K, Powers D, Stoddard G, Brooke BS, Huang LC. Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention. Surg Open Sci 2023; 13:27-34. [PMID: 37351188 PMCID: PMC10282558 DOI: 10.1016/j.sopen.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 06/24/2023] Open
Abstract
Background Multimodal perioperative patient education and expectation-setting can reduce post-operative opioid use while maintaining pain control and satisfaction. As part of a quality-improvement project, we developed a standardized model for perioperative education built upon the American College of Surgeons (ACS) Safe and Effective Pain Control After Surgery (SEPCAS) brochure to improve perioperative education regarding opioid use and pain control. Material and methods Our study was designed within the Define, Measure, Analyze, Improve, Control (DMAIC) quality-improvement framework. Patients were surveyed about the adequacy of their perioperative education regarding pain control and use of prescription opioid medication. After gathering baseline data, a multimodal educational intervention based on the SEPCAS brochure was implemented. Survey responses were then compared between groups. Results Twenty-seven subjects were included from the pre-intervention period, and thirty-nine were included from the post-intervention period (n = 66). Those in the post-intervention period were more likely to report receiving the appropriate amount of education regarding recognizing the signs of opioid overdose and how to safely store and dispose of opioid medications. The majority of patients who received the SEPCAS brochure reported that it was useful in their post-operative recovery and that it should be given to every patient undergoing surgery. Conclusions The ACS SEPCAS brochure is an effective tool for improving patient preparation to safely store and dispose of their opioid medication and recognize the signs of opioid overdose. The brochure was also well received by patients and perceived as an effective educational material.
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Affiliation(s)
- Zachary Fender
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Kathy Phan
- Division of Pharmacy, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Damien Powers
- Division of Pharmacy, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Gregory Stoddard
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Lyen C. Huang
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
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Bleicher J, Johnson JE, Cain BT, Shaw RD, Acher AA, Gleason L, Barth RJ, Chu DI, Jung S, Melnick D, Kaphingst KA, Smith BK, Huang LC. Surgical Trainee Perspectives on the Opioid Crisis: The Influence of Explicit and Hidden Curricula. JOURNAL OF SURGICAL EDUCATION 2023; 80:786-796. [PMID: 36890045 PMCID: PMC10200738 DOI: 10.1016/j.jsurg.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE In order to effectively create and implement an educational program to improve opioid prescribing practices, it is important to first consider the unique perspectives of residents on the frontlines of the opioid epidemic. We sought to better understand resident perspectives on opioid prescribing, current practices in pain management, and opioid education as a needs assessment for designing future educational interventions. DESIGN This is a qualitative study using focus groups of surgical residents at 4 different institutions. SETTING We conducted focus groups using a semistructured interview guide in person or over video conferencing. The residency programs selected for participation represent a broad geographic range and varying residency sizes. PARTICIPANTS We used purposeful sampling to recruit general surgery residents from the University of Utah, University of Wisconsin, Dartmouth-Hitchcock Medical Center, and the University of Alabama at Birmingham. All general surgery residents at these locations were eligible for inclusion. Participants were assigned to focus groups by residency site and their status as junior (PGY-2, PGY-3) or senior resident (PGY-4, PGY-5). RESULTS We completed 8 focus groups with a total of 35 residents included. We identified 4 main themes. First, residents relied on clinical and nonclinical factors when making decisions about opioid prescribing. However, hidden curricula based on unique institutional cultures and attending preferences heavily influenced residents' prescribing practices. Second, residents acknowledged that stigma and biases towards certain patient groups influenced opioid prescribing practices. Third, residents encountered barriers within their health systems to evidence-based opioid prescribing. Fourth, residents did not routinely receive formal education on pain management or opioid prescribing. Residents recommended several interventions to improve the current state of opioid prescribing, including standardized prescribing guidelines, improved patient education, and formal training during the first year of residency. CONCLUSIONS Our study highlighted several areas of opioid prescribing that can be improved upon through educational interventions. These findings can be used to develop programs aimed at improving residents' opioid prescribing practices, both during and after training, and ultimately the safe care of surgical patients. ETHICS STATEMENT This project was approved by the University of Utah Institutional Review Board, ID # 00118491. All participants provided written informed consent.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | | | - Brian T Cain
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Alexandra A Acher
- Department of Surgery, University of Utah, Salt Lake City, Utah; Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Lauren Gleason
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard J Barth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Daniel I Chu
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah Jung
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - David Melnick
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kimberly A Kaphingst
- Department of Communication, Unversity of Utah and Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
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Dahlem C, Monteiro C, Mendes E, Martinho J, Oliveira C, Bettencourt M, Coelho M, Neves P, Azevedo L, Granja C. Modulating Influence of State Anxiety on the Effect of Midazolam on Postsurgical Pain. J Clin Med 2023; 12:jcm12072669. [PMID: 37048752 PMCID: PMC10095355 DOI: 10.3390/jcm12072669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Anxiety contributes to postsurgical pain, and midazolam is frequently prescribed preoperatively. Conflicting results have been described concerning the impact of midazolam on pain. This study aims to evaluate the effect of systemic midazolam on pain after open inguinal hernia repair, clarifying its relationship with preoperative anxiety. A prospective observational cohort study was conducted in three Portuguese ambulatory units between September 2018 and March 2020. Variable doses of midazolam were administered. Postsurgical pain was evaluated up to three months after surgery. We enrolled 306 patients and analyzed 281 patients. The mean preoperative anxiety Numeric Rating Scale score was 4 (3) and the mean Surgical Fear Questionnaire score was 22 (16); the mean midazolam dose was 1.7 (1.1) mg with no correlation to preoperative anxiety scores. Pain ≥4 was present in 67% of patients 24 h after surgery and in 54% at seven days; at three months, 27% were classified as having chronic postsurgical pain. Preoperative anxiety correlated to pain severity at all time points. In multivariable regression, higher midazolam doses were associated with less pain during the first week, with no apparent effect on chronic pain. However, subgroup analyses uncovered an effect modification according to preoperative anxiety: the decrease in acute pain occurred in the low-anxiety patients with no effect on the high-anxiety group. Inversely, there was an increase in chronic postsurgical pain in the very anxious patients, without any effect on the low-anxiety group. Midazolam, generally used as an anxiolytic, might impact distinctively on pain depending on anxiety.
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Affiliation(s)
- Caroline Dahlem
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Entre Douro e Vouga, 4520-211 Santa Maria da Feira, Portugal
| | - Catarina Monteiro
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Eunice Mendes
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Joana Martinho
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
| | - Carmen Oliveira
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Margarida Bettencourt
- Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, Portugal
| | - Miguel Coelho
- Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, EPE, 3810-164 Aveiro, Portugal
| | - Paula Neves
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Luís Azevedo
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Cristina Granja
- CINTESIS@RISE—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Bleicher J, Brooke BS, Bayless K, Anderson Z, Beckstrom J, Zhang C, Presson AP, Huang LC, Buys MJ. Postoperative opioid prescribing, use and pain trends following general surgery procedures: a retrospective cohort study among veterans comparing non-opioid versus chronic opioid users. Reg Anesth Pain Med 2022; 47:rapm-2021-103382. [PMID: 35523480 PMCID: PMC10473845 DOI: 10.1136/rapm-2021-103382] [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: 12/01/2021] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Understanding postoperative opioid use patterns among different populations is key to developing opioid stewardship programs. METHODS We performed a retrospective cohort study on opioid prescribing, use, and pain after general surgery procedures for patients cared for by a transitional pain service at a veterans administration hospital. Discharge opioid prescription quantity, 90-day opioid prescription, and patient reported outcome pain measures were compared between chronic opioid users and non-opioid users (NOU). Additionally, 90-day total opioid use was evaluated for NOU. RESULTS Of 257 patients, 34 (13%) were on chronic opioid therapy, over 50% had a mental health disorder, and 29% had a history and/or presence of a substance use disorder. NOU were prescribed a median (IQR) of 10 (7, 12) tablets at discharge, while chronic opioid users were prescribed 6 (0, 12) tablets (p<0.001). 90-day opioid prescription (not including baseline opioid prescription for chronic users) was 10 (7, 15) and 6 (0, 12) tablets, respectively (p=0.001). There were no differences in changes in pain intensity or pain interference scores during recovery between groups. Median 90-day opioid use post discharge for NOU was 4 (0, 10) pills. DISCUSSION Non-opioid and chronic opioid users required very few opioid pills following surgery, and patients on chronic opioid therapy quickly returned to their baseline opioid use after a small opioid prescription at discharge. There was no difference in pain recovery between groups. Opioid prescribing guidelines should include patients on chronic opioid therapy and could consider recommending a more conservative prescribing approach.
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Affiliation(s)
- Josh Bleicher
- Surgery, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
| | - Benjamin Sands Brooke
- Surgery, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
- Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Kimberlee Bayless
- Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Zachary Anderson
- Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Julie Beckstrom
- Surgery, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
| | - Chong Zhang
- Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Angela P Presson
- Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Lyen C Huang
- Surgery, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
| | - Michael Jacob Buys
- Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
- Anesthesia, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
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6
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Bleicher J, Fender Z, Johnson JE, Cain BT, Phan K, Powers D, Wei G, Presson AP, Kwok A, Pickron TB, Scaife CL, Huang LC. Use of post-discharge opioid consumption patterns as a tool for evaluating opioid prescribing guidelines. Am J Surg 2021; 224:58-63. [DOI: 10.1016/j.amjsurg.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 12/15/2022]
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Valeberg BT, Dihle A, Småstuen MC, Endresen AO, Rustøen T. The effects of a psycho-educational intervention to improve pain management after day surgery: A randomised clinical trial. J Clin Nurs 2021; 30:1132-1143. [PMID: 33432643 DOI: 10.1111/jocn.15659] [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] [Received: 01/02/2020] [Revised: 11/17/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of a psycho-educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function. BACKGROUND Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed. DESIGN Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used. METHODS Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi-squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures. RESULTS After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence. CONCLUSIONS No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed. RELEVANCE TO CLINICAL PRACTICE Day surgery patients' postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01595035).
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Affiliation(s)
- Berit T Valeberg
- Oslo Metropolitan University, Oslo, Norway.,University of South-East, Borre, Norway
| | | | - Milada C Småstuen
- Oslo Metropolitan University, Oslo, Norway.,University in Oslo, Oslo, Norway
| | | | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Lin L, Lee B, Wang R. Effects of a Symptom Management Program for Patients With Type 2 Diabetes: Implications for Evidence‐Based Practice. Worldviews Evid Based Nurs 2019; 16:433-443. [DOI: 10.1111/wvn.12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Li‐Ying Lin
- Department of Nursing Kaohsiung Veterans General Hospital Kaohsiung City Taiwan
- Department of Nursing Meiho University Kaohsiung City Taiwan
| | - Bih‐O Lee
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
- Nursing Department Kaohsiung Medical University Hospital Kaohsiung City Taiwan
| | - Ruey‐Hsia Wang
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
- Department of Medical Research Kaohsiung Medical University Hospital Kaohsiung City Taiwan
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Orhan C, Lenoir D, Favoreel A, Van Looveren E, Yildiz Kabak V, Mukhtar NB, Cagnie B, Meeus M. Culture-sensitive and standard pain neuroscience education improves pain, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain: a pilot randomized controlled trial. Physiother Theory Pract 2019; 37:633-645. [PMID: 31280694 DOI: 10.1080/09593985.2019.1639231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare the effectiveness of culture-sensitive and standard pain neuroscience education (PNE) on pain knowledge, pain intensity, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain (CLBP).Methods: Twenty-nine Turkish first-generation migrants with CLBP were randomly assigned to the culture-sensitive (n = 15) or standard PNE (n = 14) groups. Primary (pain knowledge, pain intensity, and disability) and secondary outcomes (pain beliefs, catastrophization, and fear of movement) were evaluated at baseline, immediately after the second session of PNE (week 1), and after 4 weeks.Results: There was a significant main effect of time in pain knowledge (p < .001), pain intensity (p = .03), disability (p = .002), organic and psychological pain beliefs (p = .002, p = .01), catastrophization (p = .002), and fear of movement (p = .02). However, no significant difference was found between groups in terms of all outcome measures (p > .05).Conclusions: Both PNE programs resulted in improvements in knowledge of pain, pain intensity, perceived disability, and pain cognitions. Nevertheless, the superiority of the culture-sensitive PNE approach could not be proved. Therefore, maybe migrants who are living in the host country for longer length of time do not need culturally adapted therapies due to cultural integration, while these adaptations might be essential for the recent migrants or the autochthonous population in Turkey. Further research is required to investigate the effects of culture-sensitive PNE alone or in combination with physiotherapy interventions in recent migrants or Turkish natives with CLBP.
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Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Belgium
| | - An Favoreel
- Department of Physiotherapy, De Sleep Health Center, Ghent, Belgium
| | - Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Belgium
| | - Vesile Yildiz Kabak
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Naziru Bashir Mukhtar
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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10
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Orhan C, Cagnie B, Favoreel A, Van Looveren E, Akel U, Mukhtar NB, De Meulemeester K, Pas R, Lenoir D, Meeus M. Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study. Musculoskelet Sci Pract 2019; 39:1-9. [PMID: 30439644 DOI: 10.1016/j.msksp.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions. OBJECTIVES To culturally adapt PNE material for first-generation Turkish patients with chronic pain. DESIGN A modified Delphi study with three consecutive rounds. METHOD A total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials. RESULTS Results on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material. CONCLUSIONS Culturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices.
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Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium.
| | | | - Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium.
| | - Umit Akel
- Fysio Point Maastricht, Maastricht, Netherlands.
| | | | | | - Roselien Pas
- Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium.
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
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