Abstract
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP’s recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors’ (n = 63) vs. nurses/physiotherapists’ (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments’ pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children’s pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs’ pain competencies/clinical practices in pain assessment and administration of analgesics.
Highlights
Healthcare seeks to decrease postoperative pain to ensure better and faster postoperative mobilization [1]
Despite advances in perioperative protocols, pain remains a very frequent clinical symptom seen by orthopedic surgeons and a major reason for patients seeking medical assistance [3], and pain management after e.g., orthopedic procedures remains suboptimal for many patients [4]
37% of orthopedic patients reported pain to be severe at its highest intensity [5], where postoperative pain remains a problem that requires consensus and joint efforts [5]
Summary
Healthcare seeks to decrease postoperative pain to ensure better and faster postoperative mobilization [1]. Postoperative pain pathways identify populations at risk for 30-day readmissions and emergency department visits that are not due to post discharge complications [2]. 37% of orthopedic patients reported pain to be severe at its highest intensity [5], where postoperative pain remains a problem that requires consensus and joint efforts [5]. Pain in elderly surgical patients is undermanaged, to the extent that the worst pain intensity in the first post-surgery day was the best predictor of patient satisfaction [8]. Age was a major confounder of the sex differences in postoperative pain outcomes, especially in patients older than 50 years [10], and failure to manage pain in elderly populations might lead to serious adverse events [11]. Orthopedic patients are less satisfied than other patients in terms of pain management [8]
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