Journal articles on the topic 'Pain management medication interventions'
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Shade, Marcia, Kyle Rector, and Kevin Kupzyk. "VERIFICATION OF PAIN MEDICATION ADHERENCE IN OLDER ADULTS USING INTERACTIVE VOICE REMINDERS." Innovation in Aging 3, Supplement_1 (November 2019): S926. http://dx.doi.org/10.1093/geroni/igz038.3371.
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Abstract Adherence to analgesics needs to be monitored to ensure optimal pain management and avert adverse events among older adults. mHealth reminders may encourage adherence behavior, but it is unclear if medication use ensues following the reminder. The purpose of this study was to trial the use of medication event monitoring to verify the initiation of scheduled pain medication after an mHealth reminder. Methods: N=15 adults 55 and older created Google Assistant reminders to take their scheduled pain medication and write in a pain diary. A sub sample of n= 5 participants used a Medication Event Monitoring System Cap with their scheduled pain medications over 4 weeks. Data were collected on demographics, pain severity, and medication adherence. Descriptive statistics were performed. Results: Five women with ages ranging from 56-80 years, reported pain in multiple body locations. Pain severity on average was rated at 4 and at its worst 7; with pain relief ranging from 50-90%. Adherence percentages ranged from 82% to 100%. The overall latency was M = 55 min, SD = 100 min. The average latencies varied among the 5 participants; the shortest average time was 17 minutes and the longest average time was 4.5 hours. Only 15% of pain medications were taken within 5 minutes and 64% within 30 minutes of the interactive voice assistant reminder. Conclusions: It is important to ensure a behavioral intervention promotes the desired outcome. Medication event monitoring systems may help to identify non adherent behaviors when using mHealth interventions to promote pain medication adherence.
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Taylor, Robert, Salma Lemtouni, Karen Weiss, and Joseph V. Pergolizzi. "Pain Management in the Elderly: An FDA Safe Use Initiative Expert Panel’s View on Preventable Harm Associated with NSAID Therapy." Current Gerontology and Geriatrics Research 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/196159.
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Optimization of current pain management strategies is necessary in order to reduce medication risks. Promoting patient and healthcare provider education on pain and pain medications is an essential step in reducing inadequate prescribing behaviors and adverse events. In an effort to raise awareness on medication safety, the FDA has launched the Safe Use Initiative program. The program seeks to identify areas with the greatest amount of preventable harm and help promote new methods and practices to reduce medication risks. Since the establishment of the program, FDA’s Safe Use initiative staff convened a panel of key opinion leaders throughout the medical community to address pain management in older adults (≥65 years of age). The aim of the expert panel was to focus on areas where significant risk occurs and where potential interventions will be feasible, implementable, and lead to substantial impact. The panel suggested one focus could be the use of NSAIDs for pain management in the elderly.
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Chunduri, Aparna, and Amit Kumar Aggarwal. "Multimodal Pain Management in Orthopedic Surgery." Journal of Clinical Medicine 11, no. 21 (October 28, 2022): 6386. http://dx.doi.org/10.3390/jcm11216386.
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Background: Orthopedic surgery typically results in moderate to severe pain in a majority of patients. Opioids were traditionally the primary medication to target mechanisms of pain transmission. Multimodal analgesia has become a preferred method of pain management in orthopedic practice. Utilizing more than one mode to address post-surgical pain by recruiting multiple receptors through different medications accelerates the recovery process and decreases the need for opioids. By implementing effective analgesic techniques and interventions, this practice, in turn, decreases the usage of perioperative opioids, and in the long term, prevents addiction to pain medications and risk of opioid overdose. In orthopedic surgeries, previous studies have found that multimodal analgesia has reduced early opioid usage in the postoperative course. Pain is the result of direct injury to the nervous system, with a wide variety of chemicals directly stimulating or sensitizing the peripheral nociceptors. The pathophysiology behind the mechanism of post-surgical pain, along with the importance of preoperative, perioperative, and postoperative pain regimens are emphasized. A brief overview of pain medications and their properties is provided. These medications are further categorized, with information on special considerations and typical dosage requirements. Pain management should address both neuropathic and subjective types of pain. Effective pain control requires constant reassessment with individualized strategies. Conclusion: By focusing on multimodal analgesia, anesthesiologists can now utilize newer techniques for postoperative pain relief from orthopedic surgery, with better short-term and long-term outcomes for the patient.
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Knopp-Sihota, Jennifer, Megan Nuspl, Tara MacGregor, Jennifer Reeves, and Ahsan Saleem. "HEALTHCARE AIDE-FOCUSED INTERVENTIONS TO IMPROVE PAIN MANAGEMENT IN LONG-TERM CARE." Innovation in Aging 6, Supplement_1 (November 1, 2022): 535. http://dx.doi.org/10.1093/geroni/igac059.2035.
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Abstract Pain is endemic for residents of long-term care homes, with many residents experiencing pain daily. Given that healthcare aides provide most daily care for residents, they are ideally situated to deliver timely assessment and non-drug interventions for managing resident pain. In this Cochrane-style systematic review, we searched 7 databases to identify intervention studies that included long-term care residents aged ≥60 years who received interventions to reduce chronic pain. Interventions were either delivered by healthcare aides at the resident level or were directed at healthcare aides to improve their pain management practices. We screened 400 titles/abstracts and 152 full-text articles. Nine studies met inclusion criteria and were included in a narrative review. Due to the limited number of studies and variety of study designs, data were insufficient to perform meta-analyses or thematic analysis. Three studies described pain interventions delivered by healthcare aides at the resident level reporting significant improvement of pain. Six studies described pain interventions delivered to healthcare aides. Results of these interventions were inconsistent; 2 reported significant improvements in pain-related outcomes (e.g., resident pain, monitoring of pain), 3 reported insignificant changes, and 1 reported a positive correlation between measured pain and pain medication use. We concluded that despite the paucity of research in this area, this systematic review provides preliminary support for pain interventions by healthcare aides for long-term care residents. Future research exploring interventions for healthcare aides to take greater roles in pain management could unlock further improvements in resident care.
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Ros-Cucurull, E., M. Perea, D. Romero, R. F. Palma-Álvarez, P. Pozo-Rosich, M. Torres-Ferrús, L. Grau-López, et al. "Psychological approach in headache patients with pain medication misuse in an outpatient center for drug treatment in Barcelona." European Psychiatry 41, S1 (April 2017): s876. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1766.
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IntroductionPain medication misuse is commonly found in patients under headache treatment and may produce co-morbid anxiety and depressive symptomatology. Management of this issue requires a comprehensive and integrative treatment including psychotherapy. Group interventions have been scarcely studied in addictive disorders, those interventions aims to decrease drug misuse and improve related psychiatric symptoms.AimTo study the efficacy of group interventions base on cognitive-behavior approach in patients with pain medication misuse.MethodPatients with pain medication misuse were included and were evaluated with BDI, STAI, SF36 and HIT scales (basal and at the end of treatment sessions). Patients were recruited from headache outpatient unit. Twelve sessions of one hour were performed with a cognitive-behavior approach (weekly).ResultsWe present preliminary results about the efficacy of group interventions in patients with pain medication misuse. Descriptive results pre- and post- treatment were analyzed in depressive symptoms (M = 20.14, SD = 12.25; M = 14.67, SD = 19.50) and in areas of quality of life: physical functioning (M = 48.75, SD = 31.13; M = 60.50, SD = 41.68), bodily pain (M = 12, SD = 9.25; M = 42.75, SD = 34.09), general health perceptions (M = 25.75, SD = 16.96; M = 44.25, SD = 22.33), vitality (M = 33.75, SD = 13.82; M = 48, SD = 34.82).ConclusionsPain medication misuse is commonly found in chronic headache patients, consequently worst outcomes for both pathologies. Group interventions may be useful in management of pain, anxiety and other comorbidities. Furthermore, it may favor drug use decrease and even abstinence.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Freedman, Mitchell K., Michael F. Saulino, E. Anthony Overton, Michele Y. Holding, and Ira D. Kornbluth. "Interventions in Chronic Pain Management. 5. Approaches to Medication and Lifestyle in Chronic Pain Syndromes." Archives of Physical Medicine and Rehabilitation 89, no. 3 (March 2008): S56—S60. http://dx.doi.org/10.1016/j.apmr.2007.12.002.
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Mezey, Gyöngyi Anna, Zsuzsanna Máté, and Edit Paulik. "Factors Influencing Pain Management of Patients with Osteoarthritis: A Cross-Sectional Study." Journal of Clinical Medicine 11, no. 5 (March 1, 2022): 1352. http://dx.doi.org/10.3390/jcm11051352.
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Background: Osteoarthritis (OA) is a complex disease associated with chronic pain. Many patients treat their joint pain at a symptomatic level with over-the-counter (OTC) pain medications, often without the knowledge of their physicians. The aim of this study was to provide physicians with data about osteoarthritic patients’ habits of pain management and to examine the explanatory factors of various ways of self-treatment. Methods: A cross-sectional study involving 189 patients with hip or knee OA and scheduled for joint replacement surgery was carried out. Participants filled out a self-administered questionnaire consisting of the Western Ontario and McMaster Universities Osteoarthritis Index and questions about their methods of alleviating pain. Results: 2.6% of patients did not use anything to alleviate their pain, while 63% practiced a non-pharmacological method. Diclofenac was the most frequently used drug, followed by ibuprofen. Profession had the greatest impact on medication habits; patients doing manual work were significantly more likely to take OTC non-steroidal anti-inflammatory drugs and use topical analgesics. Conclusions: Patients utilized a wide variety of pain management techniques. They seemed to use well-known painkillers, even if their side effects were less desirable. Such patients require comprehensive pain management, including educational and behavioural interventions, complemented by topical and oral medication.
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Ma, Joseph D., Victor Tran, Carissa Chan, William M. Mitchell, and Rabia S. Atayee. "Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice." Journal of Oncology Pharmacy Practice 22, no. 6 (July 9, 2016): 757–65. http://dx.doi.org/10.1177/1078155215607089.
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Background We have previously reported the development of an outpatient palliative care practice under pharmacist–physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients. Objective This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice. Methods This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed. Results Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients ( n = 80) were mostly women ( n = 44), had localized disease ( n = 42), a gastrointestinal cancer type ( n = 21), and were on a long-acting ( n = 61) and short-acting ( n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits. Conclusions A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits.
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Barseghyan, A. B., L. G. Nazaryan, and Simonyan. "Evaluation of pharmacist interventions as part of a multidisciplinary pain management team." NEW ARMENIAN MEDICAL JOURNAL, no. 3 (2022): 100–106. http://dx.doi.org/10.56936/18290825-2022.16.3-100.
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Pharmacists have an important role within the healthcare system. They can offer some services to the patients including consultation, patient education and therapeutic management. Community pharmacists can assess the type and severity of pain, monitor treatment and guide medication regulation to improve the treatment of the pain. The involvement of pharmacists in nonprescription medication counseling about pain will increase the public’s ability to understand the risks and benefits of over-the-counter drugs. Aim and objects was to study and analyze professional abilities and role of pharmacy employees during the pain management. The survey was conducted among 285 employees of licensed pharmacies in Armenia with the help of questionnaires, the number of which was determined according to “The Survey System Version 11.0”. Survey data were entered and analyzed using SPSS software package. The study was quantitative investigation and the questionnaire was developed based on the World Health Organization standard questionnaire. As a result of our research, it became clear that pharmacists have pure, indistinct knowledge about adverse reactions of over-the-counter analgesics and pharmacy employees in the Republic of Armenia have incomplete knowledge and ideas about pain management. According to the study pharmacists’ information sources was not reliable and the use of these sources in professional pharmaceutical practice were not inappropriate. Involvement of pharmacists in primary care pain management is very important and pain management training of pharmacy staffs should be encouraged. Pharmacist should be a part of a multidisciplinary pain management team and for this reason comprehensive information on pain management as well as development of practical skills should be included in continuing education programs for pharmacists.
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Lichtman, S. M., and M. K. Boparai. "Geriatric medication management: Evaluation of pharmacist interventions and potentially inappropriate medication (PIM) use in older (≥65 years) cancer patients." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 9507. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.9507.
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9507 Background: Polypharmacy and inappropriate drug use are risk factors for adverse drug reactions (ADR) and poor compliance in older cancer patients. Drug evaluations in the past have not focused on this group. An evaluation of the prevalence of PIMs, pharmacist interventions, and the number and type of medications was performed. An educational component helped patients with drug management to increase adherence, avoid drug-drug and drug-disease interactions. Methods: A geriatric clinical pharmacist reviewed patient's medications, assessed understanding of their drugs, evaluated adherence, reviewed for PIMs (Beer's criteria), identified possible ADR and side effects, and provided detailed instructions. The pharmacist collaborated with the oncologist to determine appropriate therapy for the patient. Only patients over the age of 65 were eligible for this clinic. Consults were performed from March 2008 to June 2008, this includes new and follow up visits. An additional retrospective chart review was performed on 100 patients ≥ 65 years of age seen from July 2007 to November 2007. Results: There were 154 patients who underwent a prospective consultations; 74 yrs (65–91; 58% female). The interventions were: an alternative agent was recommended (31pts/20%), drug - drug interactions identified (15/10%), problems with adherence (58/37%), drugs discontinued (54/35%), additional medication (64/42%), dose change (17/11%), pain management (28/18%) and cost issues (19/12%). More then one issue was addressed during visits. In the retrospective study, median age 72 (65 - 90), 48% were females; medications: median 8 (range 0–23). Most common classes of medications were anti-hypertensives (52%), vitamins/herbals (46%), proton pump inhibitors (32%) and lipid lowering agents (29%). The prevalence of PIMs was 11%. The most common were propoxyphene, high doses of long-acting benzodiazepines and diphenhydramine. Conclusions: A geriatric medication management evaluation resulted in 50% of patients requiring specific interventions and identification of PIMs in 11% of patients. This type of intervention can optimize care by increasing adherence and avoiding adverse drug events and their serious sequelae. No significant financial relationships to disclose.
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Jones, Laney K., Mia E. Lussier, Jasmit Brar, Mary C. Byrne, Melissa Durham, Fleurette Kiokemeister, Klaus Kjaer, et al. "Current interventions to promote safe and appropriate pain management." American Journal of Health-System Pharmacy 76, no. 11 (May 17, 2019): 829–34. http://dx.doi.org/10.1093/ajhp/zxz063.
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Abstract Purpose Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. Summary The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. Conclusion Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.
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Zhang, Lu, Howard L. McLeod, Ke-Ke Liu, Wen-Hui Liu, Hang-Xing Huang, Ya-Min Huang, Shu-Sen Sun, et al. "Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial." JMIR mHealth and uHealth 9, no. 8 (August 16, 2021): e24555. http://dx.doi.org/10.2196/24555.
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Background Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results A total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901
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Martin, Shedrick, Kimberly Tallian, Victoria T. Nguyen, Jason van Dyke, and Harminder Sikand. "Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain?" Mental Health Clinician 10, no. 4 (July 1, 2020): 215–21. http://dx.doi.org/10.9740/mhc.2020.07.215.
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Abstract Introduction Chronic lower back pain is a leading cause of disability in US adults. Opioid use continues to be controversial despite the Centers for Disease Control and Prevention guidance on chronic pain management to use nonpharmacologic and nonopioid pharmacologic interventions. The objectives of the study were to assess the impact of early physical therapy (PT) intervention on improving functionality and reducing opioid burden in patients with chronic lower back pain. Methods A single-center, retrospective chart review of patients receiving ≥6 PT visits and treated with either opioids first (OF) or PT first (PTF) therapy for chronic lower back pain were evaluated. Concomitant use of nonopioid and nonpharmacologic therapy was permitted. The Oswestry Disability Index (ODI), a survey measuring functionality, was recorded for PTF group. Pain scores and medication use including opioids were collected at treatment initiation and completion. Results One hundred and eighty patients were included in three groups: OF group (n = 60), PTF group (n = 60), and PTF + ODI group (n = 60). The PTF + ODI group had mean ODI reduction of 11.9% (P < .001). More OF patients were lost to follow up (68.3%) or failed PT (60%) compared to the PTF group, 38.3% and 3.3% (P < .001). Reduction in both opioid and nonopioid medications as well as pain scores were observed but not statistically significant. Discussion Early PT resulted in improved functionality, decreased pain, and reduced medication use upon PT completion. These findings suggest PT, along with nonopioid modalities, are a viable first-line option for the management of chronic lower back pain.
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Ceena Denny, E., and K. Jeena Priya. "Trigeminal Neuralgia: Current Concepts in the Medical Management." World Journal of Dentistry 1, no. 1 (2010): 43–46. http://dx.doi.org/10.5005/jp-journals-10015-1008.
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ABSTRACT Trigeminal neuralgia (TN), also known as tic douloureux, is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Typically, brief attacks are triggered by talking, chewing, teeth brushing, shaving, a light touch, or even a cool breeze. The pain is nearly always unilateral, and it may occur repeatedly throughout the day. The condition is characterized by intermittent one-sided facial pain. Trigeminal neuralgia can be classified based on the symptoms as typical and atypical trigeminal and according to etiology as primary or idiopathic and secondary or symptomatic. An early and accurate diagnosis of TN is important, because therapeutic interventions can reduce or eliminate pain attacks in the large majority of TN patients. Although various drugs have been used in the management of TN such as baclofen, gabapentin, phenytoin sodium, carbamazepine remains the gold standard drug of choice. Surgical approaches to pain management are performed when medication cannot control pain or patients cannot tolerate the adverse effects of the medication.
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Smalarz, Amy, Lynn Razzano, and Deb Gordon. "Impact of Postsurgical Pain Management Medication Interventions on Perianesthetic Nurses’ Time and Workflow." Journal of PeriAnesthesia Nursing 30, no. 4 (August 2015): e10-e11. http://dx.doi.org/10.1016/j.jopan.2015.05.033.
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Rozycki, Alan, Andrew S. Jarrell, Rachel M. Kruer, Samantha Young, and Pedro A. Mendez-Tellez. "Feasibility of a Nurse-Managed Pain, Agitation, and Delirium Protocol in the Surgical Intensive Care Unit." Critical Care Nurse 37, no. 6 (December 1, 2017): 24–34. http://dx.doi.org/10.4037/ccn2017528.
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BACKGROUND Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed. Protocol adherence was evaluated for interventions implemented after a nursing assessment. Patients were further divided into 2 groups on the basis of adherence, and achievement of pain and sedation goals was evaluated between groups. RESULTS Data on 41 patients were included. Of the 603 pain assessments, 422 (70.0%) led to an intervention adherent to the protocol. Of the 249 sedation assessments, 192 (77.1%) led to an adherent intervention. Among patients with 75% or greater adherent pain interventions, all interventions met pain goals with significantly less fentanyl than that used in interventions that did not meet goals. Despite 75% or greater adherence with interventions for sedation assessments, only 8.7% of the interventions met sedation goals. CONCLUSIONs A nurse-managed pain, agitation, and delirium protocol can be feasibly implemented in a surgical intensive care unit.
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Hamm, Randy. "Utilization of Pediatric Standing Orders by Triage Nurses in a Free-Standing Emergency Department." Journal of Doctoral Nursing Practice 15, no. 2 (July 1, 2022): 112–22. http://dx.doi.org/10.1891/jdnp-2021-0024.
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BackgroundPediatric pain-related complaints continue to be a common presenting factor of most emergency departments (EDs). Studies have shown that several barriers in assessing and treating pediatric pain exist, including nursing knowledge regarding appropriate pain level assessment.ObjectiveThis quality improvement study aimed to provide and evaluate specific education regarding pediatric pain management for free-standing ED triage nurses to expedite medication administration during the triage phase of an ED visit.MethodThis pre/post-test intervention study was used to measure whether the education provided to nurses working in a primarily adult patient free-standing ED increased the utilization of triage standing orders related to pediatric pain management.ResultsPaired sample t-tests results indicated a statistically significant increase (p = .000) in the percentage of patients that received pain medication during the triage phase of an ED visit after specific education was provided to triage nurses.ConclusionFree-standing ED triage nurses are more likely to follow and implement triage standing orders if education explicitly related to pain management in pediatric patients has been provided.Implications for PracticePediatric pain management education should be revisited annually to re-educate nurses on the importance of early interventions.
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Fan, Zu-Yan, Jin-Xiang Lin, Xing Li, Xiang-Wei Chen, and Xiu-Yan Huang. "The effect of pain self-management based on pain control diary on breakthrough pain." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10107. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10107.
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10107 Background: Most patients suffer from cancer pain, especially breakthrough pain. The overall incidence of breakthrough pain is estimated to be 65%. Self-management makes patients actively participating in the use of drugs, transforming their roles and adjusting their moods in order to better cure their own diseases. Therefore, the aim of the study is to discuss the effect of reducing cancer pain patients' breakthrough pain through self-management based on pain control diary. Methods: From October, 2015 to October, 2016, a total of 200 patients treated with opioids for cancer pain were randomly divided into groups. Patients in the control group were given general management including the Standard "the three steps analgesic ladder treatment for cancer pain", the traditional form of health education and psychological care; While the intervention group in addition to conventional cancer pain management, self-management based on pain control diary was applied. Through repeated intensive training, patients learned how to do self-assessment, to master the feature of their own pain, problem-solving skills and formal report to their oncologists in charge. Results: After six weeks of intervention , 10% patients in the intervention group had suffer breakthrough pain compared with 54% patients in the control group (P < 0.05). The whole processing management model is a whole process, specialization and humanization Care model for patients with advanced cancer pain management, can effectively improve patient medication compliance, reduce the cancer breakthrough pain's incidence, improve the patients,s life quality with cancer pain. The medication compliance of the intervention group was significantly higher than that of the control group(X2= 46.606, P<0.001), and in intervention group the incidence of breakthrough pain was significantly lower than that of the control group (X2= 44.148, P<0.001) Conclusions: The self management based on pain control diary is a whole process, specialization and humanization Care model for patients with advanced cancer pain management, can effectively improve patient medication compliance, reduce the cancer breakthrough pain's incidence, improve the patients's life quality with cancer pain.
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Motes, Arunee. "Pain management in the intensive care unit." Southwest Respiratory and Critical Care Chronicles 11, no. 46 (January 24, 2023): 1–6. http://dx.doi.org/10.12746/swrccc.v11i46.1133.
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Critically ill patients often experience pain from an underlying illness or injury, a recent surgical or other invasive procedure, or various interventions in the intensive care unit (ICU), e.g., endotracheal intubation, vascular access devices, nasogastric tubes, urinary catheters, mechanical ventilation, and routine nursing care, such as repositioning. Opioids remain the mainstay medication for pain control in the ICU; however, they can have adverse effects, including over-sedation, respiratory depression, opioid-induced constipation, opioid dependence and withdrawal, which result in increased length of ICU/hospital stay, health care costs, morbidity, and mortality. In this review, we summarize the mechanism of action, usual doses, side effects, recent studies of opioids that are frequently used in adult ICUs, and pain assessment tools for monitoring pain in adult ICU patients.
Keywords: analgesia, opioids, intensive care unit, pain assessment tools
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Patel, Jai Narendra, Issam Hamadeh, James Thomas Symanowski, Rebecca Edwards, Beth Susi, and Connie Edelen. "Impact of pharmacy interventions on pain management in an oncology palliative medicine (PM) outpatient clinic." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 119. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.119.
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119 Background: PM can improve the quality of life and survival for cancer patients (pts); however, the demand for PM challenges providers with delayed follow ups resulting in less than one-third of pts achieving significant pain improvement between clinic visits. Engaging pharmacists in the provision of PM may help improve pain management in cancer pts. Methods: Adult cancer pts starting a new pain regimen or requiring changes to an existing regimen at baseline were referred for pharmacy follow up in 3-7 days (assessment #1). The pharmacist evaluated each pt using the Edmonton Symptom Assessment Scale and recommended changes to the referring PM provider, prompting a 2nd follow up in 3-7 days (assessment #2). If no changes were required, pts continued therapy and returned for the final clinic visit (day 28 +/- 7). The primary endpoint was the proportion of pts achieving significant pain improvement (≥ 2-point decrease in pain score on a scale of 0-10) from baseline to final visit, which was compared to historical controls using Fisher’s Exact test. Changes in pain severity from baseline to final visit were compared using Generalized McNemar’s test, and descriptive statistics were used to describe characteristics at assessment #1. Results: Of 102 pts evaluable for the primary endpoint, 76% had stage IV disease, 58% were female, and median age was 57 yrs. Significantly more pts achieved pain improvement from baseline to final visit compared to historical controls (49% v 30%; P < 0.001). Changes in pain severity from baseline to final visit are described in the table. At assessment #1, 70% of pts required an intervention, primarily due to uncontrolled pain (72%), side effects (26%), and/or lack of response to non-pain medications (22%). The most common types of interventions were dose adjustments (62%), education (36%), and/or adding a new medication (30%). Over 90% of recommendations were accepted by the referring PM provider. The median time of assessment was 15 mins. Conclusions: Routine inclusion of pharmacists in the outpatient PM interdisciplinary team improves the effectiveness of pain management. [Table: see text]
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Oliveira, Indiara Soares, Shaiane Silva Tomazoni, Adriane Aver Vanin, Amanda Costa Araujo, Flávia Cordeiro de Medeiros, Renan Kendy Ananias Oshima, Leonardo Oliveira Pena Costa, and Lucíola da Cunha Menezes Costa. "Management of acute low back pain in emergency departments in São Paulo, Brazil: a descriptive, cross-sectional analysis of baseline data from a prospective cohort study." BMJ Open 12, no. 4 (April 2022): e059605. http://dx.doi.org/10.1136/bmjopen-2021-059605.
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ObjectiveTo describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain.DesignA descriptive, cross-sectional analysis of baseline data from a prospective cohort study.Setting and participantsA study with 600 patients with low back pain presenting in four public emergency departments from São Paulo, Brazil was conducted.Outcome measuresDiagnostic tests, pharmacological interventions, and/or referral to other healthcare professionals were collected. Descriptive analyses were used to report all outcomes.ResultsOf all patients, 12.5% (n=75) underwent some diagnostic imaging tests. Medication was administered to 94.7% (n=568) of patients. The most common medications were non-steroidal anti-inflammatory drugs (71.3%; n=428), opioids (29%; n=174) and corticosteroids (22.5%; n=135). Only 7.5% (n=45) of patients were referred to another type of care.ConclusionThere is a need for research data on low back pain from middle-income countries. There was an acceptable rate of prescription for diagnostic imaging tests. However, there were high medication prescriptions and small rates of referrals to other healthcare services. Our findings indicate that there is still a need to implement best practices in the management of acute low back pain at public emergency departments in Brazil.
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Probyn, Katrin, Hannah Bowers, Dipesh Mistry, Fiona Caldwell, Martin Underwood, Shilpa Patel, Harbinder Kaur Sandhu, Manjit Matharu, and Tamar Pincus. "Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components." BMJ Open 7, no. 8 (August 2017): e016670. http://dx.doi.org/10.1136/bmjopen-2017-016670.
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ObjectivesTo assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventionsParticipantsPeople living with migraine and/or tension-type headacheInterventionsNon-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy.We assessed the overall effectiveness against usual care on headache frequency, pain intensity, mood, headache-related disability, quality of life and medication consumption in meta-analysis.We also provide preliminary evidence on the effectiveness of intervention components and delivery methods.ResultsWe found a small overall effect for the superiority of self-management interventions over usual care, with a standardised mean difference (SMD) of −0.36 (−0.45 to −0.26) for pain intensity; −0.32 (−0.42 to −0.22) for headache-related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD=0.53 (−0.66 to −0.40)). We did not find an effect on headache frequency (SMD=−0.07 (−0.22 to 0.08)).Assessment of components and characteristics suggests a larger effect on pain intensity in interventions that included explicit educational components (−0.51 (−0.68 to −0.34) vs −0.28 (−0.40 to −0.16)); mindfulness components (−0.50 (−0.82 to −0.18) vs 0.34 (−0.44 to −0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (−0.72 to −0.40) vs −0.39 (−0.52 to −0.27)) and larger effects on mood in interventions including a cognitive–behavioural therapy (CBT) component with an SMD of −0.72 (−0.93 to −0.51) compared with those without CBT −0.41 (−0.58 to −0.24).ConclusionOverall we found that self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness.Trial registration numberPROSPERO 2016:CRD42016041291
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Janevic, Mary R., Mary Janevic, Sheria Robinson-Lane, Susan Murphy, and John Piette. "CHRONIC PAIN SELF-MANAGEMENT PRACTICES AND PREFERENCES AMONG URBAN AFRICAN AMERICAN OLDER ADULTS." Innovation in Aging 3, Supplement_1 (November 2019): S70. http://dx.doi.org/10.1093/geroni/igz038.273.
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Abstract African American older adults experience disproportionate burden from disabling chronic pain. Pain self-management interventions for this group are most effective when they integrate culturally-relevant preferences into intervention design. In the STEPS pilot trial, we collected focus group (n=23) and survey (n=57) data from African Americans age 60+ years about pain-management practices. Participants were recruited from the community and reported pain for 3+ months, with intensity >4 (0 to 10 scale). The most frequently-used pain-management strategies were exercise (75%) and prayer/Bible reading (74%). Also commonly used were healthy eating (61%), OTC medications (65%), and herbal supplements (51%). Focus group themes provided more nuanced information, including reasons for avoiding prescription pain medications, positive experiences with topical treatments, the value of movement, and the role of social support. Findings reveal strong engagement in pain self-care in this population. Interventions can build on existing practices by incorporating spirituality and appealing options for physical activity.
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Weisman, Steven. "Naproxen for Post-Operative Pain." Journal of Pharmacy & Pharmaceutical Sciences 24 (February 12, 2021): 62–70. http://dx.doi.org/10.18433/jpps31629.
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Introduction: Post-operative pain is a common type of acute pain that can require therapeutic intervention. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage post-operative pain and help reduce or eliminate the use of opioids. Current pain management guidelines recommend administration of NSAIDs as first line therapy to all post-operative surgical patients, unless contraindicated, as one method to minimize opioid use. Methods: This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by the author. Literature for controlled trials involving naproxen in a peri-procedural setting was included. Comprehensive meta-analyses and individual clinical trial reports were summarized. Results: Naproxen was shown to have significant efficacy in treating pain following different surgical interventions, eliminating, or reducing the use of rescue opioids in many trials. Importantly, naproxen did not demonstrate an increased rate of bleeding or other adverse events in this elevated-risk population. Conclusion: As a generally safe and effective medication, clinical consideration should be given to naproxen when developing any comprehensive, patient-specific, pain management plan.
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Strasser, Florian, Paul Walker, and Eduardo Bruera. "Palliative Pain Management: When Both Pain and Suffering Hurt." Journal of Palliative Care 21, no. 2 (June 2005): 69–79. http://dx.doi.org/10.1177/082585970502100202.
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Patients with advanced cancer frequently experience intractable pain without sufficient response to a conventional pharmacological approach. One reason for refractory pain at the end of life can be the bidirectional nature of pain and suffering. Three terminally ill patients were assessed using a multidimensional palliative pain concept, including sensory, affective, cognitive, and existential components. In these patients, resistant pain did not equal insufficient eradication of the nociceptive input, but also suffering. Unrelieved emotions, depressive or anxious symptoms, delirium, difficulties communicating, or chemical coping influenced the expression of pain, illuminating the phenomenon of somatization. Palliative pain treatment integrated analgesic treatments, psychological, rehabilitative, and existential interventions, in consideration of individual expectations and outcomes. With the disciplined assessment and alternative multidisciplinary palliative approach, the quality of life of three terminally ill cancer patients with intractable pain could be enhanced, and unnecessary interventions and escalation of medications avoided.
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Patel, Krupali, Kimia Godazandeh, Jianhua Wu, and Joanna M. Zakrzewska. "The journeys of patients with trigeminal neuralgia on a background of multiple sclerosis." Pain Management 11, no. 5 (September 2021): 561–69. http://dx.doi.org/10.2217/pmt-2021-0001.
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Aim: Multiple sclerosis (MS) is well recognized as a secondary cause for trigeminal neuralgia (TN). In this case series, we detail the management of all the patients with TN and MS (pwTNMS) presenting to a specialist unit. Materials & methods: A prospective patient database was used to extract key clinical data on pharmacological, psychometric and surgical management of 20 pwTNMS. Results: 65% of pwTNMS underwent surgical interventions for management of their pain.12/20 achieved remission periods, through surgery and/or medication. Significant improvement was noted on the global impression of change illustrated by a p < 0.001. Conclusion: pwTNMS require a multifaceted approach combining polypharmacy, surgical interventions and psychological support. Developing self-management skills is crucial if patients are to live well with pain.
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Sreenivasagan, Swapna, Aravind Kumar Subramanian, Abirami Selvaraj, and Anand Marya. "Pain Perception Associated with Mini-Implants and Interventions for Pain Management: A Cross-Sectional Questionnaire-Based Survey." BioMed Research International 2021 (November 29, 2021): 1–9. http://dx.doi.org/10.1155/2021/4842865.
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Background. Orthodontists use mini-implants temporarily as an effective mode of skeletal anchorage devices. The placement of mini-implants can cause pain and discomfort to the patients. Patients often develop swelling, and the pain could interfere with their daily activities. Practitioners tend to prescribe antibiotics and pain medication for management. Objectives. The main objectives of this study are to evaluate the pain perception and discomfort due to mini-implant placement experienced by the patient and evaluate the interventions for pain management commonly practiced among orthodontists. Materials and Methods. The study was designed as a questionnaire-based cross-sectional study. A total of 271 patients were assessed, for whom 625 mini-implants (ranging from 1.2 to 2 mm diameter and length 8-14 mm) were placed. Pain scores were assessed using the VAS and the “Faces” pain rating scale to collect data about discomfort in daily activity and function. Data was collected from 244 patients. A total of 155 orthodontists were questioned regarding the prescription of medications and the interventions for managing pain and adverse effects. Results. Average pain score among female subjects was 16.71 and among men was 13.5. The highest pain scores were recorded for palatal mini-implants with an average score of 36.29 and the least for interradicular mini-implants with an average score of 9.02. Among the subjects, 47.9% of them took analgesics, and the most commonly prescribed analgesics were paracetamol (39%). Swelling at the site is where the mini-implants were placed, and ulceration due to implants were commonly dealt with the excision of the surrounding soft tissue, composite placement, and palliative care with oral analgesic gels. Conclusion. Female subjects had more mini-implants placed, and female subjects had also given more pain scores than their male counterparts. Palatal mini-implants caused the highest pain, followed by mini-implants placed at the infrazygomatic crest and the buccal shelf region. Palatal mini-implants caused maximum discomfort during speech and eating, followed by the mini-implant in the buccal shelf and the infrazygomatic crest region that also caused difficulty in yawning and laughing. Infiltration anesthesia was commonly given for the placement of interradicular implants and extra-alveolar mini-implants. Paracetamol was the most prescribed by the orthodontists, and more than half the doctors did not regularly prescribe antibiotics.
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Bettinger, Jeffrey, Jacqueline Cleary, and Jeffrey Fudin. "Amid COVID-19 crisis, pain therapeutics telehealth services by pharmacist clinicians fill unique void and mitigate risk." Medicine Access @ Point of Care 4 (January 2020): 239920262094703. http://dx.doi.org/10.1177/2399202620947035.
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Patients with chronic pain syndromes are facing additional challenges from syndrome coronavirus 2 (SARS-CoV-2) virus compared with the general population. New reasons for compounded social isolation and commensurate opioid dose creeping and suicidality/anxiety, difficulty in obtaining legitimate medications, proper comprehensive evaluations, ongoing opioid risk stratification for opioid abuse/misuse, safe opioid tapers if necessary, and other opportunities for pharmacist intervention are clear. We discuss opportunities for pharmacist-run telehealth visits, reimbursement for services, and various aspects of interventions during this time of international emergency where all healthcare professionals have been asked to step up to help combat the mutual threat of COVID19. Clinical pharmacists in every specialty area are part of the essential healthcare workforce, but those practicing pain management in particular are in unique positions to assist all providers in adhering to chronic pain guidelines and various government mandates, and to foster optimal outcomes to complex patients with chronic pain. Furthermore, those that are available by telemedicine allow for improved access to quality and appropriate pain medication management, and additionally support opioid risk mitigation strategies, helping fill an unmet access to those at higher risk. This practice has the potential to help offset primary care provider workload, allowing for a decreased overall burden, especially in a complex, time-consuming, and high-risk patient population.
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Varghese, Susy, Jaya Sheela Amaram-Davila, and Marina C. George. "Prior authorization process improvement for pain medications in an oncology unit: Timely initiation of test claim request form." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 7050. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.7050.
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7050 Background: Oncology patients with extensive metastatic disease and advanced-stage cancer frequently require controlled medications for pain managements. Insurers require Prior Authorization (PA) for high-cost specialty medications including: Hydromorphone, Oxycodone, Oxymorphone, Fentanyl, Nucynta, Lyrica and Lidocaine patch. Failure to obtain PA may delay patient hospital discharge and attainment of discharge medications, increase patient medication costs, increase hospital readmissions and emergency visits, and exacerbate clinical complications. In order to avoid delays, providers must submit a Claim Request (CR) to initiate the PA process. PA usually takes 48-72 hours after the CR is submitted; therefore, timely CR submission in anticipation of discharge is imperative. Baseline rates for initiating CR in a timely manner was 15%. A quality improvement project was conducted to increase provider-initiated CRs for prescribed pain medications requiring PA and to demonstrate a sustainable process, anchored by development of new policy. Methods: The project revised the provider-initiated CR process by implementing the following interventions: The Electronic Medical Record (EHR) was modified to create a ‘quick link’ to facilitate CR form submissions. The link was made available to providers via their dashboard for easy access to the CR form.The medication reconciliation process was revised to require nurses to send reminders to providers for any of the seven discharge medications requiring CR submission for PA. A new component was incorporated into the discharge planning process by discussing PA and CR during interdisciplinary rounds. Providers and nurses were educated about the revised process. Results: Rates for timely CR submission were collected from the EHR biweekly for 3 months post-intervention. Post-intervention, 77% of timely CR claims increased from baseline of 15% to 87%. Due to the timely initiation of CR, some medications were deemed not to require PA, and the percentage of PA requirement reduced from 95% to 55%. In addition, up to 16% of patients had money refunded as a result of timely CR submission. Conclusions: The new process was effective for ensuring an efficient and effective process for patients who require high-cost controlled medications for pain management, reducing waste and providing a quality experience for the patient. As a result of the project, the new process has become policy and is now being used on other units in the institution for additional medications that requires CR and PA.
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Bello, Shakirat I., and Ibrahim K. Bello. "Impacts of Community Pharmacists on Self-medication Management among Rural Dwellers, Kwara State Central, Nigeria." Dhaka University Journal of Pharmaceutical Sciences 12, no. 1 (September 2, 2013): 1–9. http://dx.doi.org/10.3329/dujps.v12i1.16294.
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The role of pharmacist has not only advanced from medication dispensing but also to direct patient care and pharmaceutical interventions aiming at enhancing the populace wellbeing. The objective of this research was to assess the impact of rural community pharmacist interventions on self-medications and disease prevalence among rural settings in the Kwara State Central, Nigeria. A descriptive, cross-sectional study was conducted in eight rural communities with a pre-piloted questionnaire. Data obtained from respondents were computed with Statistical Package for Social Sciences (SPSS) Version 16 using descriptive analysis procedures, and relationships between variables were tested using the chi square. Respondents between the age of 40 and 50 years dominated with 42.3% and majority (88.1%) of the rural residents were illiterates. Farming was the major occupation of the respondents and survived on less than ten thousand naira Nigeria money ($63) per month. Among the combinations of drugs abused by the respondents, the regimen containing combination of prednisolone, diclofenac and paracetamol had the highest users. The least used combination was ibuprofen, diclofenac plus prednisolone. These combinations were taken twice daily by the majority participants. The most common reasons given for self-medications were osteoarthritis (31.1%), poverty (17.4%), general body pain (14.3%), inadequate of health facilities (4.6%), ignorance (4.3%) among others. The intervention offered by the pharmacists had reduced the mean systolic blood pressure significantly (P < 0.05) from 161 mmHg to 129 mmHg and diastolic blood pressure from 104 mmHg at baseline to 86 mmHg. Postintervention evaluation revealed the impact of the pharmacists, as the respondents with dyspepsia at baseline significantly (P < 0.05) reduced from 220 to 53 participants. Dhaka Univ. J. Pharm. Sci. 12(1): 1-9, 2013 (June) DOI: http://dx.doi.org/10.3329/dujps.v12i1.16294
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Osuch, Elzbieta, and Andre Marais. "An update on available pain medications." South African Family Practice 60, no. 3 (July 12, 2018): 14–20. http://dx.doi.org/10.4102/safp.v60i3.4877.
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Pain is a complex interaction of sensory, emotional and behavioural factors. Chronic pain is among the most common reasons for seeking medical attention. In contrast to acute pain, where the goal is primary pain relief, the effective management of chronic pain is complex and not fully understood. Multimodal pain therapy is often required to treat chronic or persistent pain syndromes. These include pharmacological agents, physical interventions, behavioural changes and surgical approaches. Pharmacological interventions are the most widely used therapeutic options to treat acute and persistent pain.
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Boumezrag, Maryam, and Filip Banovac. "Oncologic Interventions: Periprocedural Medications." Seminars in Interventional Radiology 39, no. 04 (August 2022): 406–10. http://dx.doi.org/10.1055/s-0042-1758079.
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AbstractSignificant advances in ablative and endovascular therapies have allowed interventional radiology to play a substantial role in the management of patients with malignant neoplasms. The evolution of these procedures and the optimization of patient outcomes and experience must take into account various elements of the periprocedural period. Some of the most important considerations within the periprocedural period are the pharmacologic agents used to avoid infectious complications, decrease pain, and manage side effects. In this article, we discuss some of the most commonly used medications in interventional oncology procedures including antibiotics, narcotics, sedatives, antiemetics, and others.
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Saha, Saibal Kumar, Anindita Adhikary, Ajeya Jha, and Vijay Kumar Mehta. "Use of Interventions to Overcome Medication Non-Adherence." International Journal of Asian Business and Information Management 12, no. 3 (July 2021): 289–318. http://dx.doi.org/10.4018/ijabim.20210701.oa18.
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Medication non-adherence is a global problem and has existed for centuries. Patients have paid a very high price for their behaviour of non-adherence in the form of impaired cost, prolonged diseases, a burden to family, or even by their lives. In the era of science and technology where there is a solution for every odd problem, the issue of medication non-adherence can also find a remedy. This paper tries to highlight the factors of non-adherence and looks for solutions through various forms of technology. The review of different published literature highlights the findings of researchers and tries to assimilate a solution for addressing the prolonged problem of medication non-adherence.
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Franzetti, Megan, Emily Dries, Brady Stevens, Lisa Berkowitz, and Sheldon C. Yao. "Support for osteopathic manipulative treatment inclusion in chronic pain management guidelines: a narrative review." Journal of Osteopathic Medicine 121, no. 3 (February 22, 2021): 307–17. http://dx.doi.org/10.1515/jom-2019-0284.
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Abstract Context Osteopathic manipulative treatment (OMT) is used to treat chronic pain conditions. However, few guidelines focusing on chronic pain management include recommendations for OMT. Objectives To evaluate previous literature on the use of OMT for improving chronic pain. Methods A literature search was conducted on MEDLINE/PubMed and ScienceDirect on August 26–27, 2019, using the terms “osteopathic,” “chronic,” and “pain,” yielding a total of 312 MEDLINE/PubMed articles and 515 ScienceDirect articles. Eligibility criteria required that studies investigate pain, functional status, or medication usage through an experimental design, focusing on human subjects with chronic pain who had various forms of OMT administered by osteopathically trained individuals in which the comparator group received no intervention, a sham or placebo, or conventional care. Three authors independently performed literature searches and methodically settled disagreements over article selection. Results In the 22 articles included in our study that examined OMT use in chronic pain conditions, we evaluated primary outcomes of pain (22; 100%) and functional status (20; 90.9%), and the secondary outcome of medication usage (3; 13.6%). The majority of articles showed that OMT resulted in a significant decrease in pain levels as compared to baseline pain levels or the control group (20; 90.9%) and that OMT resulted in an improvement in functional status (17; 77.3%). In articles that did not find a significant difference in pain (2; 9.1%) or functional status (3; 13.6%), there were overall outcomes improvements noted. All articles that investigated medication usage (3; 13.6%) showed that OMT was effective in decreasing patients’ medication usage. Our study was limited by its small sample size and multimodal comparator group exclusion. Conclusions OMT provides an evidence-based management option to reduce pain levels, improve functional status, and decrease medication usage in chronic pain conditions, especially low back pain (LBP). Pain management guidelines should include OMT as a resource to alleviate chronic pain.
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A Cos, Travis. "The Pain Academy: An Evaluation of a Primary Care Brief Psychoeducational Program for Persistent Pain." Current Research in Psychology and Behavioral Science (CRPBS) 3, no. 1 (February 16, 2022): 1–6. http://dx.doi.org/10.54026/crpbs/1037.
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Persistent pain affects 20% of adults and can impair one’s daily functioning and well-being. Psychoeducational group interventions can be effective in aiding pain management and coping strategies, however the time commitment for most evidence-based programs (10-20 hours) leads to access barriers and delivery challenges in primary care. A mixedmethods, program evaluation was conducted on a low intensity, three-session, manualized group pilot psychoeducational intervention in a primary care practice, emphasizing pain education, behavioral strategies, and pain-alleviating activities. Eighty-two percent of the clinic’s panel of individuals with persistent pain and being prescribed opioid pain medication (N=128) attended at least one class (N=105). Attendees experienced significant pre-post improvements in self-reported pain functioning and favorable satisfaction ratings by patients and medical staff. However only 51% attended all three groups, despite frequent class offerings and heavily encourage by the patient’s medical providers. This study reviews the potential promise and limitations of a low-intensity, limited session pain group to aid pain-related functioning. Additional investigation is warranted to optimize participant attendance, group format and frequency, and outcome assessment.
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Smith, Sadie, and Jill Eckert. "Interventional Pain Management and Female Pelvic Pain: Considerations for Diagnosis and Treatment." Seminars in Reproductive Medicine 36, no. 02 (March 2018): 159–63. http://dx.doi.org/10.1055/s-0038-1676104.
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AbstractChronic pelvic pain (CPP) is a recurring and/or constant pain of at least six months duration that has resulted in either functional or psychological disability that can require interventional treatments. Chronic pelvic pain can be visceral, somatic, neuropathic, or a combination. Patients with CPP often suffer from concurrent bowel or bladder dysfunction, sexual dysfunction, depression, and anxiety. The complexity of chronic pelvic pain can be challenging to treat, which can lead to frustration for both patients and their physicians. Treatment should involve a comprehensive and multi-modal approach involving psychosocial support, counseling, physical therapy, medication management, and interventional procedures. This manuscript will focus both on the etiologies and the interventional treatment options for chronic pelvic pain.
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Simone, C. B., N. Vapiwala, M. K. Hampshire, and J. M. Metz. "An Internet-based survey evaluating attitudes of cancer patients towards pain intervention." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 18540. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.18540.
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18540 Background: Pain is a common symptom among cancer patients (pts), but many pts experience inadequate medical management for pain. There are little data quantifying reasons that cancer pts fail to receive optimal analgesic treatment. This study evaluated those reasons and investigated the causes of pain in cancer pts. Methods: An Internet-based questionnaire assessing pt demographics and pain symptoms was piloted with pts and healthcare providers and posted on the OncoLink (http://www.oncolink.org) website. The questionnaire included 22 queries evaluating medication utilization, pain control and attitudes regarding pain medications. The questionnaire was IRB approved and held on a secure server. Between 11/05–1/06, 99 pts responded to the questionnaire. They were predominantly Caucasian (76%), female (78%) and pursued education beyond high school (66%). The most common diseases included cancer of the breast (51%), lung (8%) and brain (6%). Cancer treatment included surgery (75%), chemotherapy (63%) and radiation (45%). Results: Half (49%) of the respondents reported pain directly from their cancer and 42% complained of pain due to cancer treatment. This pain was primarily intermittent (42%) or chronic (35%). Most (77%) pts did not use medication specifically to help manage their pain. Analgesic usage trended less in women (19% vs. 36%, p = 0.10), Caucasians (19% vs. 38%, p = 0.06), and pts with higher education levels (17% vs. 26%, p = 0.29) but did not reach statistical significance. Reasons most commonly cited for not taking analgesics included the healthcare provider not recommending medications (86%), fear of becoming addicted or dependent (80%) and an inability to pay for medication (75%). Participants experiencing pain, but not taking analgesics, sought alternative measures for pain control such as physical therapy (84%), massage (7%) and acupuncture (4%). Conclusions: Although many cancer pts experience pain regularly, both from their cancer and cancer treatment, most pts in this study did not seek out analgesics. Pts do seek complementary therapies for pain control. Healthcare providers should regularly have open discussions with pts regarding pain symptoms. Further study will be needed to evaluate attitudes of pts towards pain based on disease condition. No significant financial relationships to disclose.
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Kan, Kristin, Sara Shaunfield, Madeleine Kanaley, Avneet Chadha, Kathy Boon, Carolyn C. Foster, Luis Morales, Patricia Labellarte, Deneen Vojta, and Ruchi S. Gupta. "Parent Experiences With Electronic Medication Monitoring in Pediatric Asthma Management: Qualitative Study." JMIR Pediatrics and Parenting 4, no. 2 (April 23, 2021): e25811. http://dx.doi.org/10.2196/25811.
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Background Electronic medication monitoring (EMM) is a digital tool that can be used for tracking daily medication use. Previous studies of EMM in asthma management have been conducted in adults or have examined pediatric interventions that use EMM for less than 1 year. To understand how to improve EMM-enhanced interventions, it is necessary to explore the experiences of parents of children with asthma, recruited from outpatient practices, who completed a 12-month intervention trial. Objective The objective of our study was to use qualitative inquiry to answer the following questions: (1) how did using an EMM-enhanced intervention change parents'/caregivers’ experiences of managing their child’s asthma, and (2) what do parents recommend for improving the intervention in the future? Methods Parents were recruited from the intervention arm of a multicomponent health intervention enhanced by Bluetooth-enabled sensors placed on inhaler medications. Semistructured interviews were conducted with 20 parents of children aged 4-12 years with asthma. Interviews were audio-recorded, transcribed, and inductively analyzed using a constant comparative approach. Results Interview participants reflected an even mix of publicly and privately insured children and a diverse racial-ethnic demographic. Parents discussed 6 key themes related to their experience with the EMM-enhanced intervention for the management of their child's asthma: (1) compatibility with the family's lifestyle, (2) impact on asthma management, (3) impact on the child’s health, (4) emotional impact of the intervention, (5) child’s engagement in asthma management with the intervention, and (6) recommendations for future intervention design. Overall, parents reported that the 12-month EMM intervention was compatible with their daily lives, positively influenced their preventive and acute asthma management, and promoted their child's engagement in their own asthma management. While parents found the intervention acceptable and generally favorable, some parents identified compatibility issues for families with multiple caregivers and frustration when the technology malfunctioned. Conclusions Parents generally viewed the intervention as a positive influence on the management of their child's asthma. However, our study also highlighted technology challenges related to having multiple caregivers, which will need to be addressed in future iterations for families. Attention must be paid to the needs of parents from low socioeconomic households, who may have more limited access to reliable internet or depend on other relatives for childcare. Understanding these family factors will help refine how a digital tool can be adopted into daily disease management of pediatric asthma.
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Sieberg, Christine B., Anna Huguet, Carl L. von Baeyer, and Shashi S. Seshia. "Psychological Interventions for Headache in Children and Adolescents." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 39, no. 1 (January 2012): 26–34. http://dx.doi.org/10.1017/s0317167100012646.
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Headache in children and adolescents represents a number of complex and multifaceted pain syndromes that can benefit from psychological intervention. There is good evidence for the efficacy of cognitive behavioral therapy, relaxation training, and biofeedback. The choice of intervention is influenced by patients' age, sex, family and cultural background, as well as by the nature of stressors and comorbid psychiatric symptoms. Management must always be family-centered. Psychological treatments are essential elements in the multidisciplinary, biopsychosocial management of primary headache disorders, particularly for those with frequent or chronic headache, a high level of headache-related disability, medication overuse, or comorbid psychiatric symptoms. Future studies of efficacy and effectiveness of psychological treatment should use the International Headache Society's definition and classification of headache disorders, and stratify results by headache type, associated conditions, and treatment modality.
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Leis, Julie A., and Colleen I. Morrison. "An Integrative Review of Arts-Based Strategies for Addressing Pain and Substance Use Disorder During the Opioid Crisis." Health Promotion Practice 22, no. 1_suppl (May 2021): 44S—52S. http://dx.doi.org/10.1177/1524839921996065.
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In October 2017, the U.S. Department of Health & Human Services declared the opioid crisis a national public health emergency and prioritized identifying effective, evidence-based strategies for pain management and the prevention and treatment of substance use disorder (SUD). Increasingly, the arts have become more widely established and accepted as health-promoting practices in the United States and around the world. As the U.S. health care system moves toward greater integration of physical and behavioral health, arts-based interventions should be considered among potential complementary approaches for managing pain and preventing and treating SUD. We conducted an integrative literature review to summarize and synthesize the evidence on the role of the arts in the management of pain and in the prevention and treatment of SUD, including opioid use disorder. The available evidence suggests that music interventions may reduce participants’ pain, reduce the amount of pain medication they take, improve their SUD treatment readiness and motivation, and reduce craving. Few studies examined art forms other than music, limiting the ability to draw conclusions for those art forms. Given the critical need to identify effective strategies for managing pain and preventing and treating SUD, future research on arts-based interventions should examine maintenance of pain management and SUD treatment benefits over time and outcomes related to SUD prevention.
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Lee, Jaclyn, Katherine Delaney, Molly Napier, Elizabeth Card, Brittany Lipscomb, Jay Werkhaven, Amy S. Whigham, Andrew D. Franklin, Stephen Bruehl, and Amanda L. Stone. "Child Pain Intensity and Parental Attitudes toward Complementary and Alternative Medicine Predict Post-Tonsillectomy Analgesic Use." Children 7, no. 11 (November 19, 2020): 236. http://dx.doi.org/10.3390/children7110236.
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Parental attitudes regarding pain interventions and perceptions of their child’s pain intensity likely influence the decision to administer postoperative analgesics. Our study examined the impact of daily fluctuations in child pain intensity and parental attitudes regarding complementary and alternative medicine (CAM) on analgesic administration following pediatric tonsillectomy. Parents of children undergoing tonsillectomy (n = 33) completed a survey assessing CAM attitudes and a 7-day postoperative electronic daily diary to record their child’s daily pain intensity and analgesic medications (acetaminophen, ibuprofen, or oxycodone). Generalized linear mixed models with Poisson distributions evaluated the effects of within-person (child’s daily pain intensity) and between-person (average postoperative pain, parental CAM attitudes) components on the number of medication doses administered. Higher daily pain intensity was associated with more oxycodone doses administered on a given day, but not acetaminophen or ibuprofen. Positive parental CAM attitudes were associated with less oxycodone use, beyond the variations accounted for by the child’s daily pain intensity and average postoperative pain. Both parental CAM attitudes and their child’s daily pain intensity were independently associated with parental decisions to administer opioids following tonsillectomy. Understanding factors influencing individual variability in analgesic use could help optimize children’s postoperative pain management.
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Hagmann, Chelsea, Joseph Ma, Arlene Cramer, Michelle Russell, Alexandra Dullea, Yael Cohen-Arazi, and Eric Roeland. "Administration of the ASCO Pain Survey to identify patient education deficiencies in patients with cancer." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 68. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.68.
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68 Background: The Doris Howell Palliative Care (PC) Outpatient Consultation Service consists of a multidisciplinary team. Reasons for consultation include pain management, treatment of other physical symptoms, education about non-drug options for pain, and advanced care planning. To assess methods used for patient education, the PC team administered the ASCO pain survey to those prescribed opioid pain medications. Methods: The survey was a 26-item questionnaire evaluating patient education content communicated by a provider to a patient during a routine clinic visit. Twenty surveys were completed anonymously. After survey review, the outpatient PC team developed an intervention to address patient education concerns. The intervention consisted of written and verbal instructions on pain medication management reviewed by the PC nurse with the patient and/or caregiver at the end of the outpatient visit. Another twenty surveys were completed anonymously with patients after intervention implementation. Time required to complete the intervention was less than two minutes per patient. The Fisher’s exact test was used to analyze the differences between surveys completed with or without the intervention. Results: The majority of patients stated that his/her provider adequately explained the use (n = 40, 100%), side effects (n = 37, 93%), and storage (n = 32, 80%) of pain medications, regardless of the intervention. Both groups also indicated that the provider and/or nurse adequately explained the risks associated with medical history (n = 34, 85%) and other medications while taking pain medications (n = 33, 83%). The intervention did increase understanding to avoid sharing pain medications (75% vs. 85%, p < 0.05) and to use a lock box to secure pain medications (45% vs. 60%, p < 0.05). Additionally, asking patients if family members have a history of alcohol or substance abuse was also significant (p < 0.05). Conclusions: Written and verbal instructions as an intervention improved patient understanding to avoid sharing pain medications and to secure pain medications in a lock box.
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Liao, Yo-Jen, Ying-Ling Jao, Diane Berish, and Lisa Kitko. "Barriers and Facilitators of Pain Management in Persons With Dementia in Long-Term Care: A Scoping Review." Innovation in Aging 5, Supplement_1 (December 1, 2021): 164. http://dx.doi.org/10.1093/geroni/igab046.629.
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Abstract Approximately 50% of individuals with dementia regularly experience moderate to severe pain, which is largely undermanaged. Several studies have explored the barriers and facilitators of pain management for persons with dementia; yet the evidence has not been systematically reviewed. This review aimed to synthesize current evidence on the barriers and facilitators of pain management in persons with dementia in long-term care. A PRISMA guided literature search was conducted in PubMed, CINAHL, and PsycINFO. Titles, abstracts, and full texts were screened. Included articles were original research examining the barriers or facilitators of pain assessment and treatment in individuals with dementia in long-term care. Quality assessment was conducted using the Risk of Bias tool and Johns Hopkins Level of Evidence. Ten studies were identified, including four quantitative studies, five qualitative studies, and one with both quantitative and qualitative research. Barriers of pain management identified include residents’ ability to self-report pain, pain medication side effects, need discrepancy among residents and their families, reluctance in administering analgesics, lack of pain assessment tools, lack of guidance in providing nonpharmacological interventions, and lack of clinical guidelines. Facilitators of pain management include clinicians with caring and enthusiastic characteristics, clinicians’ knowledge of residents, positive relationships among clinicians, good communication skills, using validated pain assessment tools, understanding pain indicators, clinical experience, and need-driven continuing education. These results can guide clinical practice in long-term care. Interventions should be developed to target these barriers and facilitators and improve pain management in persons with dementia.
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Thapa, Sagun, Luppana Kitrungrote, and Jintana Damkliang. "Chronic pain experience and pain management in persons with spinal cord injury in Nepal." Scandinavian Journal of Pain 18, no. 2 (April 25, 2018): 195–201. http://dx.doi.org/10.1515/sjpain-2018-0019.
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Abstract Background and aims: Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal. Methods: A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method. Results: The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs. Conclusions: SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal. Implications: This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.
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Tripathi, Shiva, Munukutla Venkata, James Hill, and Joanna Harrison. "Non-pharmacological interventions for managing pain in community-dwelling older adults." British Journal of Community Nursing 27, no. 1 (January 2, 2022): 28–30. http://dx.doi.org/10.12968/bjcn.2022.27.1.28.
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Pain is a complex and common issue within older adults. This complexity can be a direct result of comorbidities and the subsequent polypharmacy. The effective control of pain in older adults needs more than just pharmacological management. Non-pharmacological interventions have been demonstrated to be beneficial when combined with pain medications. This commentary critically appraises a systematic review that examines the effectiveness of non-pharmacological interventions for the management of pain in community dwelling older adults.
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Kircher, Janeva, Amy L. Drendel, Amanda S. Newton, Sukhdeep Dulai, Ben Vandermeer, and Samina Ali. "Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation." CJEM 16, no. 06 (November 2014): 449–57. http://dx.doi.org/10.1017/s1481803500003468.
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ABSTRACTObjective:Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children’s MSK pain, both in the ED and postdischarge.Methods:We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care.Results:A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes.Conclusions:Documentation of the assessment and management of children’s pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ‘‘door to analgesia’’ time for children in pain.
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Mazer, Laura S., Pamela J. Lovett, Joanne M. Miller, Nancy E. Pitruzzello, Margaret K. Boone, and Joan M. Irizarry Alvarado. "Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention." Journal of Perioperative Practice 30, no. 11 (November 7, 2019): 345–51. http://dx.doi.org/10.1177/1750458919886720.
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Purpose Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction. Methods Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016. Patient interviews determined reasons for not attending appointments, involvement in goal setting, engagement in pain management planning, and satisfaction with postoperative pain management. Results Retrospective chart reviews and interviews were conducted after the intervention (May–July 2017). Scheduling changes increased attendance at preoperative pain consultations by 14 percentage points (50% vs 64%). Those who attended consultations were more involved in goal setting and decisions and were more satisfied. Conclusions Preoperative pain consultations with opioid-tolerant patients can increase satisfaction through realistic goal setting and involvement in the pain management plan.
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Gritsenko, Karina. "Timing of Neuraxial Pain Interventions Following Blood Patch for Post Dural Puncture Headache." Pain Physician 2;17, no. 2;3 (March 14, 2014): 119–25. http://dx.doi.org/10.36076/ppj.2014/17/119.
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Post dural puncture headache (PDPH) is a common complication of interventional neuraxial procedures. Larger needle gauge, younger patients, low body mass index, women (especially pregnant women), and “traumatic” needle types are all associated with a higher incidence of PDPH. Currently, an epidural blood patch is the gold-standard treatment for this complication. However, despite the high PDPH cure rate through the use of this therapy, little is known about the physiology behind the success of the epidural blood patch, specifically, the time course of patch formation within the epidural space or how long it takes for the blood patch volume to be resorbed by the body. Of the many unanswered and debated topics related to PDPH and epidural blood patches, one additional specific question that may alter clinical management is when it is safe for patients who have experienced a disruption of the thecal space and have undergone this procedure to have a subsequent epidural or spinal procedure, such as a neuraxial anesthetic (i.e. a spinal anesthetic for an elective outpatient procedure) or an interventional pain procedure for chronic pain management. This question becomes more unclear if the new procedure includes a steroid medication. As an example, an older patient presents with a history of lumbar disc disease and during lumbar epidural steroid injection, an inadvertent wet tap occurs leading to PDPH. Following management with fluids, caffeine, medications, and a successful epidural blood patch, it remains unclear as to when would be the best time frame to consider a second lumbar epidural steroid injection. We identified the 3 main risk factors of subsequent interventional neuraxial procedures as (1) disruption of the epidural blood patch and ongoing reparative processes, (2) epidural procedure failure, and (3) infection. We looked at the literature, and summarized the existing literature in order to enable health care professionals to understand the time course of dural repair as well as the risks of subsequent neuraxial procedures after epidural blood patches. This review poses the question using an evidence based review to discuss the appropriate time course to proceed. Key words: Post dural puncture headache, epidural steroid injection, wet tap, timing of therapy
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Wong, Siu-Fun, Cham Phuong Nguyen, Mark Bounthavong, Kezia Bechtoldt, and Elvin Hernandez. "Outcome assessment of an oral chemotherapy management clinic: A preliminary report." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 105. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.105.
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105 Background: Many oral chemotherapy (OC) drugs are used in the United States. The dosage regimens of OC increase the risks of nonadherence and drug interactions leading to potential adverse consequences affecting therapeutic outcomes and patient safety. A new OC management clinic was developed where patients (pts) receive comprehensive OC and concurrent medication (CM) education and symptom management services. Follow-up cares are provided to assure continual patient education, monitoring, and safety assessments. Currently there are no published data in OC clinic practice model and outcomes. We design this evaluation to measure the effectiveness of this practice model in patient care. Methods: Pts referred to the OC management clinic by the medical oncologists were enrolled. Pt demographics, depression scores, CMs, and types and outcome of interventions at initial, 3-day, 7-day, and 3-month follow-ups were collected. Adherence and persistence rates were monitored. Results: Retrospective cohort analyses were performed in 30 pts (9 males and 21 females, mean age 64.5). Majority of pts were college and high school graduates; social drinkers; non-smokers; with advanced stage cancer (stage III = 37%, IV = 27%); and no caregiver. Pts were predominately not depressed with Zung self-rating mean score of 36 (SD, 7.72) at baseline. The most common cancer diagnosis was breast (20%), followed by colon (17%), rectal (13%), and lung (6.7%). Capecitabine was the most common agent prescribed. Pts had an average 12.7 CMs and co-morbid conditions of hypertension (43%), chronic pain (43%), and diabetes (37%). Number and complexity of interventions (categories: adverse events (ADR), adherence, drug-interactions, medication error, symptom management) decreased over measured time periods. Complete resolution or improved response seen in 67% of interventions resulting in cost avoidance (49%). Optimal adherence (no missed dose) and persistence (completion of therapy) of OC were detected in at least 67% of patients. Conclusions: This evaluation demonstrated the effectiveness of OC management clinic in delivering early interventions, resulting in decreased incidence of ADR, non-adherence, drug interactions, and medication errors over time.
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Swarm, Robert A., Judith A. Paice, Doralina L. Anghelescu, Madhuri Are, Justine Yang Bruce, Sorin Buga, Marcin Chwistek, et al. "Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 17, no. 8 (August 2019): 977–1007. http://dx.doi.org/10.6004/jnccn.2019.0038.
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In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.