Should It Hurt?-Experiences of Out-Patient Clinic-Based Hysteroscopy.

#36889 Closing the gaps in postoperative pain management: challenges and future perspectives

BackgroundGiven the importance and pivotal role of nurses in pain management and control, this study was conducted to determine the nurses’ knowledge and attitudes toward in emergency departments.MethodsThis study was designed and conducted as a descriptive-analytical cross-sectional study. Nurses’ attitude and knowledge towards pain management and control and relationship between their demographic characteristics have been assessed. Nurse Attitude Survey (NAS) and Pain management and control principles assessment Test (PMPAT) questionnaires were used.ResultsTotally 400 volunteers, including 148 (37.2%) male and 250 (62.8%) female nurses recruited from 23 hospitals in East Azerbaijan, Iran, with a mean age of 30.88 years (± 6.04 SD) and age range between 22 and 53 years old. The crude mean score of participants’ knowledge of pain management and control was 12.51 (± 2.77 SD), and standardized mean score was 40.34 (± 8.92 SD), which was low at 84.8% and moderate in 15.3% of the participants. Older nurses and nurses who previously participated in pain retraining courses had significantly less knowledge about pain management and control (r= -0.104, P = 0.038), and (r= -0.148, P = 0.003) respectively. The crude mean score of participants’ attitudes toward pain control and management was 15.22 (± 2.56 SD), and standardized mean score was 60.87 (± 10.26 SD). Nurses’ attitudes have become more negative with the increase of their work experience (r = -0.168, P = 0.001), and previously participation in pain retraining courses (r =-0.207, P < 0.001). Older nurses and highly educated nurses had significantly more negative attitudes towards pain control and management (r = -0.153, P = 0.002), and (r= -0.126, P = 0.005), respectively.ConclusionsThe current study revealed that pain management and control knowledge in most emergency nurses was low, and most of them had a moderate attitude. We need more scientific and comprehensive pain management and control training courses to improve knowledge and attitude among health workers and nurses.

Category:Pain ManagementIntroduction/Purpose:The opioid epidemic in the United States continues to take lives. As one of the top prescribing groups, orthopaedic surgeons must tailor post-surgical pain control to minimize the potential for harm from prescription opioid use. Patients often reference their own pain threshold as a benchmark for how they will tolerate the pain of surgery, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual threshold for heat stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self- reported pain tolerance and their actual prescription narcotic medication usage after foot and ankle surgery.Methods:This was a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a large, multispecialty orthopaedic practice over a one year period. Demographic data, procedural details and anesthesia type were collected. Narcotic usage data including number of pills dispensed and pill counts performed at the first postoperative visit were obtained. Patients were contacted via email or telephone between 7-19 months postoperatively, and asked to respond to the validated statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients scored their pain threshold on a scale of 1- 100 with 0 being “pain intolerant” and 100 a ”high pain threshold" and ranked their expectations of the pain after surgery and satisfaction with pain management on respective five-point Likert scales. Data was analyzed using a Spearman’s correlation.Results:Of the 486 patients who completed surveys, average age was 51.24 years, 32.1% were male and 7.82% current smokers. After controlling for age and anesthesia type, both agreement with the validated statement and higher pain tolerance score had a weak negative correlation with pills taken (r=-0.13, p=0.004 and r=-0.14, p=0.002, respectively); patients with higher perceived pain thresholds took fewer opioid pills after surgery (Table 1). Correlation between high expectations of postoperative pain and pills taken was weakly negative (r=-0.28, p=<0.001) (Table 1). Patients who found surgery more painful than they expected took less pain medication. There was a small, positive correlation between pain tolerance and satisfaction with pain management (r=0.12, p=0.008), indicating that patients with a relatively high pain tolerance had more satisfaction (Table 1).Conclusion:Assessment of both subjective description and quantitative score of a patient’s pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control regimens. Unexpectedly, patients who found surgery less painful than expected actually took a greater number of opioid pills. This may highlight an educational opportunity regarding postoperative pain management in order to reduce narcotic requirement. Setting expectations on safe utilization of prescribed pain medications may also increase satisfaction. This study provides useful information for surgeons to customize pain management regimens and to perform effective preoperative education and counseling regarding postoperative pain management.Table 1.Correlation Between Pain Threshold Assessment, Expectation of Postoperative Pain and Satisfaction with Postoperative Pain Management and Opioid Medication TakenSpearman Correlation Coefficientp-valueAgreement with statement “pain doesn’t bother me as much as it does most people” and opioid intake-0.130.004Increasing quantitative pain threshold score and opioid intake-0.140.002Assessment of postoperative pain as more painful than expected and opioid intake-0.28<0.001Increasing satisfaction with postoperative pain management and opioid intake0.120.008

Pain Prevalence, Pain Management, and the Need for Pain Education in Healthcare Undergraduates

What’s New in the Management of Pain in Children

Background: Patient satisfaction is a key indicator of healthcare quality, particularly about postoperative pain management. Abdominal surgery remains one of the most common major procedures performed in teaching hospitals across Nigeria. However, previous studies have reported prolonged hospital stays, delayed recovery, and increased postoperative complications due to inadequate pain control. Despite the high volume of abdominal surgeries, there is limited evidence on the most effective pain management strategies to improve patient satisfaction. Notably, many patients in federal teaching hospitals in South-West Nigeria continue to express dissatisfaction following surgery. This study examined pain management strategies that enhance patient satisfaction following abdominal surgery in selected federal teaching hospitals in South-Western Nigeria. Methods: A qualitative research design was employed. Twelve patients undergoing postoperative abdominal surgery were purposively selected until data saturation was achieved. Semi-structured interviews were conducted using an interview guide, and the data were analyzed thematically. Results: Six major themes emerged from the analysis: (1) patients’ experiences of abdominal surgical pain, (2) satisfaction with current pain management methods, (3) factors promoting coping mechanisms, (4) fear of drug-related adverse effects, (5) strategies adopted for pain management, and (6) patients’ suggestions for improving pain control. Conclusion: The study concluded that the use of a combination of pain management strategies significantly enhanced patient satisfaction following abdominal surgery. It is recommended that hospital management implement policies that support the use of multimodal pain management approaches by nurses, with a focus on personalized and compassionate care, to optimize postoperative outcomes and patient satisfaction.

BackgroundMedical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women’s experience with pain management during the process, particularly in low resource settings. The aim of this study is to better understand women’s experiences of pain with MA and strategies for improving quality of care.MethodsThis qualitative study was conducted as part of a three-arm randomized, controlled trial in Nepal, Vietnam, and South Africa to investigate the effect of prophylactic pain management on pain during MA through 63 days’ gestation. We purposively sampled seven parous and seven nulliparous women with a range of reported maximum pain levels from each country, totaling 42 participants. Thematic content analysis focused on MA pain experiences and management of pain compared to menstruation, labor, and previous abortions.ResultsMA is relatively less painful compared to giving birth and relatively more painful than menstruation, based on four factors: pain intensity, duration, associated symptoms and side effects, and response to pain medications. We identified four types of pain trajectories: minimal overall pain, brief intense pain, intermittent pain, and constant pain. Compared to previous abortion experiences, MA pain was less extreme (but sometimes longer in duration), more private, and less frightening. There were no distinct trends in pain trajectories by treatment group, parity, or country. Methods of coping with pain in MA and menstruation are similar in each respective country context, and use of analgesics was relatively uncommon. The majority of respondents reported that counseling about pain management before the abortion and support during the abortion process helped ease their pain and emotional stress.ConclusionsPain management during MA is increasingly essential to ensuring quality abortion care in light of the growing proportion of abortions completed with medication around the world. Incorporating a discussion about pain expectations and pain management strategies into pre-MA counseling and providing access to information and support during the MA process could improve the quality of care and experiences of MA patients.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000017729, registered January 8, 2013.

Pain Medicine and Management: Just the Facts. Wallace MS, Staats PS, eds. New York: McGraw-Hill, 2004. ISBN 0-07-14118-28. 379 pages, $54.95. Subspecialty certification in pain management is now available for diplomats of the anesthesiology, neurology, physical medicine and rehabilitation, and psychiatry boards. Pain Medicine and Management: Just the Facts is a text designed to prepare the reader for taking the certification exam. This 379-page study guide consists of 70 chapters presented in an easy to read format to assist in examination preparation and to function as a quick reference for evaluating painful conditions. The index is well laid out with major topics and subtopics listed. The bulleted format makes reading this text easy, but at times limits the completeness of the chapters. One weakness of this text is that there is not an abundance of figures. In particular, several image-guided interventional techniques are described in a stepwise fashion in table format without helpful figures. As with any compilation text, there are several areas of overlap among the sections, but these just serve as reinforcement of the various processes outlined, which is beneficial in a study aide. The text is divided into nine sections ranging from test preparation, through patient evaluation and treatment to evaluation of disability. Section I is a single chapter devoted to test preparation and planning. It provides a brief content outline of the Pain Medicine Certification Examination Content Outline of the American Board of Anesthesiology and touches on general study techniques. Section II provides a succinct review of the physiology of nociceptive and neuropathic pain and is especially complete in its presentation. Section III reviews the evaluation of the pain patient from history and physical examination through diagnostic testing. The chapters describing electromyography, nerve conduction studies, and quantitative sensory testing will be of particular benefit to the anesthesia-based pain physician, who might not perform such diagnostic testing in his or her practice, yet is responsible for such knowledge in the certification examination. Analgesic pharmacology is discussed in section IV. In addition to the typical systemic analgesics, sodium and calcium channel antagonists and various other analgesic adjuncts are included within this section. The use of tables to present the properties of these medications provides a quick reference guide for clinical situations. While published before the controversy that has enveloped COX-2 inhibitors, the authors do mention the higher incidence of serious cardiovascular events with rofecoxib. Section V reviews management techniques of acute pain, including patient-controlled analgesia, regional anesthetic techniques, and continuous perineural catheters. Tables describing dosing guides and side effect profiles are included. This section includes examples of standing orders from the author’s institution that aid in establishing an acute pain service. Of particular benefit are the intrathecal analgesic algorithms and the discussion of the potential complications. Section VI is dedicated to regional pain syndromes, with reviews of diagnostic strategies and therapeutic option for pain syndromes on an anatomic basis. The authors again have used both algorithms and tables to facilitate reviewing the differential diagnosis of the regional pain syndromes. These representations are especially beneficial in the chapters describing headache and abdominal and pelvic pain. However, the tables occasionally have too much information, which may prompt the reader to skip or merely glance at the text. Section VII is devoted to chronic pain management. These chapters outline diagnostic feature and therapeutic options for pain states related to cancer, complex regional pain syndrome, and fibromyalgia. In addition to reviewing interventional techniques, discussion of biopsychosocial factors and physical therapy approaches to chronic pain syndrome are presented. With up to 15% of the certification examination covering topics of pain in the geriatric, pediatric, and pregnant populations, these chapters are of particular interest. Section VIII describes special techniques in pain management, including neurolytic and ablative procedures. Chapters on complementary and alternative medicine, acupuncture, and prolotherapy are discussed. This is another area where the anesthesia-based pain management physician would benefit significantly in exam preparation, as these topics are not generally covered. Also this section discusses some of the controversial pain topics, including discography, intradiscal electrothermal annuloplasty, nucleoplasty, and lysis of adhesion. Each topic is presented with minimal bias and with supporting literature. The inclusion of the various neurosurgical techniques of pain management is likely solely for academic and test preparatory reasons, as it is unlikely that anyone sitting for the pain management certification examination would be performing these procedures. Section IX pertains to disability evaluation. The most significant part of this chapter provides a foundation for using the guides of the American Medical Association to impairment and disability, as well as describing some of the issues surrounding return to work. There is a chapter reviewing medical and legal evaluations, which are often excluded from interventional pain management texts. In summary, Pain Medicine and Management: Just the Facts is a comprehensive evidenced-based review text suitable for the certification examination. Independent of the reader’s medical discipline or training level, this text provides a foundation for the multispecialty approach to pain management.

Patient experiences of outpatient hysteroscopy

Editorial I: Acute pain management: scientific evidence revisited

Pain experience with outpatient hysteroscopy: A prospective cohort study

This paper is a report of a study to describe women's experiences and their self-management of postoperative pain after elective cardiac surgery. Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery. Semi-structured interviews were conducted in 2004-2005 with 10 women 1-2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1-2 weeks before the interviews, providing more nuances to the experiences of pain and pain management. Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what women's expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable. Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.

Pain expectation and controllability can modulate pain processing. However, little is known about age-related effects on these cognitive factors involved in pain control. This study assessed age-related brain changes associated with pain expectation and controllability. 17 healthy older adults (9 men; 65.65±4.34years) and 18 healthy younger adults (8 men; 20.56±5.56years) participated in the study. Pain evoked potentials and pain ratings were recorded while participants received painful electrical stimuli under two different conditions of pain controllability over the intensity of the stimulation (self-controlled vs. computer controlled) and two conditions of pain expectations (high vs. low pain). Although the intensity of the painful stimulation was kept constant, all participants showed reduced pain perception in the controllable and low pain expectancy conditions. However, older participants showed reduced amplitudes of pain evoked potentials in the time window between 150 and 500ms after stimulus onset as compared to younger participants. Moreover, younger participants showed greater negative amplitudes from 80 to 150ms after stimulus onset for uncontrollable versus controllable pain. These results suggest that although cognitive pain modulation is preserved during ageing, neural processing of pain is reduced in older adults. This research describes the impact of age on cognitive pain modulation evoked by the manipulation of pain controllability and pain expectations. Our findings constitute a first step in the understanding of the greater vulnerability of older individuals to chronic pain. Moreover, we show that older adults can benefit from cognitive pain control mechanisms to increase the efficacy of pain treatments.

To document children's (ages 6-15 years) descriptions of their pain management at home following tonsillectomy. Audio-taped interviews of 80 children were transcribed and coded. Data for each response category were tabulated. Children reported they had more pain after surgery than expected, the pain medicine helped to take their pain away, taking the pain medicine was associated with a negative response by some children, and cold liquids/food by mouth provided pain relief. Findings provide insight into children's perspective of pain management at home following tonsillectomy and methods for relieving their pain.

Pain Management from Basics to Clinical Practice