The Role of Peptides in Pain Management.

Paediatric pain education: A call for innovation and change

What’s New in the Management of Pain in Children

Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure

An Update: Institutional Quality Improvement Initiative for Pain Management for Pediatric Cancer Inpatients, 2007–2010

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.

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

Background: Effective pain management requires precise knowledge and competent skills in practice. Nurses should have a solid foundation of pain knowledge and develop good practice pain management. Little is documented towards nurse’s knowledge and practice of pain management among critical ill patients in the study area. Objective: To examine the level of knowledge, practice & associated factors of nurses towards critically ill patients pain management at federal hospitals, Addis Ababa, Ethiopia September to October 2020. Method: A cross-sectional study design was conducted among nurses, who work at federal hospitals of Addis Ababa, Ethiopia from September 15 to October 15, 2020. All intensive care unit nurses was participated in the study. Data was collected by using self-administered structured questionnaire and entered into Epi info version 7 and imported to SPSS version 23.0 software for analysis. Associations was analyzed by using bivariate and multivariate logistic regression model. The findings were expressed with 95% CI and odd ratio and P-value<0.05. Result: Knowledge of nurses towards pain management in the study area is 64.9%. Among many factors contributed to the nurses’ pain management knowledge in the Multivariate logistic regression: work load (AOR, 8.8, CI95%, 1.45-53.39), training related to ICU (AOR, 10.8, CI95%, 1.07-109.42), reading of guidelines (AOR, 10.11, CI95%, 1.36-75.22), educational status (AOR, 16.38, CI95%, 1.02-261.9), and practice of nurse towards pain management (AOR, 6.17, CI95%; 1.38-27.56) were associated with knowledge of pain management. Nurses’ practice of pain management in the study area is 56.5%. Similarly having a training related to intensive care unit (AOR, 19.95, CI95%, 3.03-130.9), and knowledge of nurse towards pain management (AOR, 5.30, CI95%; 1.3-21.68) were significantly associated with practice of nurses on pain management. Conclusion and recommendation: The overall nurses’ pain management knowledge in federal hospitals of Addis Ababa relative to Mekelle hospitals is good. Taking training, reading guidelines and level of education of nurses were significant predictors of nurse’s knowledge. Receiving a training related to intensive care unit and having adequate knowledge of pain management were also associated with practice of pain management. Therefore, the need to give trainings and prepare guideline regarding pain assessment and management might escalate to address pain management among nurses.

SP59 Breakthrough cancer pain management: recommendations and international guidelines

Editorial I: Acute pain management: scientific evidence revisited

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.

Assistant Professor of Anesthesiology Wake Forest University School of Medicine Winston-Salem, North CarolinaAcute Paediatric Pain Management: A Practical Guide. Edited by Neil S. Morton. Philadelphia, Saunders, 1998. Pages: 296. List Price: $29.95.This book is edited by Neil S. Morton from the Department of Anaesthesia, Intensive Care, and Pain Management in the Royal Hospital for Sick Children at the University of Glasgow. All of the contributors are currently in practice in Europe, either Scotland or Denmark.The book is divided into 10 sections that include pain prevention and management, developmental pain, pain assessment, pharmacology of analgesics, local and regional anaesthesia, opioids, nonpharmacologic alternative techniques, sedation, and specific plans for pain management. At the end of each chapter, the key learning points are summarized in a list and highlighted. The book has no pictures and very few diagrams. Tables are used frequently, are easy to locate, and often contain important clinical information. A list for further reading concludes each chapter. The book has several appendices that contain examples of protocols and general information on specific techniques.The initial chapter is entitled, “Pain Prevention and Management,” but is really about the rationale for pain management and education. It is concise, with useful summary tables. The book continues with an adequate overview of the development of pediatric pain perception but does not incorporate this information into the clinical management of pain during development.The pain assessment section makes good use of tables. An excellent overview of the value of the different pain scales is provided, but it contains no description of the content of the actual scales themselves. However, the appendix does contain the more practical face scale, analog scale, and the poker chips scale.The book continues with a section on pharmacology of analgesics. This chapter is written at the basic level, with many sweeping generalizations and little or no explanation or discussion of the exceptions to the generalities.The local and regional, opioid, and nonopioid technique sections are better written. However, not all techniques are given the same attention, and some are only mentioned as possibilities. The local and regional section does not use enough tables and is further hampered by the lack of diagrams and pictures. The opioid section provides many tables, recipes, and protocols that are useful as guidelines with better references than elsewhere. Many different uses of the opioids are covered, with a good discussion of their side effects.The section on nonpharmacologic techniques is poorly developed. In addition, many of the alternative approaches to pain management, both pharmacologic and nonpharmacologic, are not mentioned.The sedation section is well written and contains good, sound information. Included are sample protocol sheets from the Royal Hospital for Sick Children. Numerous techniques are discussed with the focus on entonox, benzodiazepines, and opioids. Propofol is not mentioned, and the discussions of ketamine, barbiturates, and chloral hydrate are limited. The subsequent section on specific plans for pain prevention and control is a valuable addition; it outlines the concerns and considerations for many common pediatric procedures. This is a unique section and provides benefit for those learning about these procedures.In summary, the book provides a good overview of basic pain management in children. Specific referencing would have added to the scientific validity of several of the chapters. Objectives are clearly stated for each chapter, and tables are used liberally to enhance understanding and emphasize salient points. Overall, the book is well written and easy to understand. It is small, compact, and fits into the pocket of a laboratory coat. This book would be of most benefit to those interested in gaining a better understanding of pain and pain management in children from the anesthesiologist’s and perioperative physician’s perspective, particularly those in training in anesthesia and the surgical specialties.

Hospitalized Children With Limited English Proficiency: The Strive to Improve Analgesia.

The new JCAHO pain standards: Implications for pain management nurses

Post-Surgical pain should be consistently assessed and documented as vital signs as well as has to be better communicated and adequately managed accordingly. However, there is a limited study regarding pain assessment and management documentation in Ethiopia. This study aimed to determine pain assessment documentation, pain management compliance with WHO guidelines, and its barrier. A cross-sectional retrospective study design mixed with quantitative and qualitative study types was employed. Three hundred sixty-five Patient cards were reviewed from four public hospitals in the West Shoa zone; Central Ethiopia, as well as four key informants groups, were interviewed. WHO guideline was used to review the patient card and a semi-structured questionnaire was used to interview the key informants. Descriptive statistics were used to describe the socio-demographic characteristics; and pain characteristics, and texts, tables, and graphs were used to present the results. Data were analyzed using SPSS-20 and Data from the key informants was thematically analyzed. From the total of 365 patient cards reviewed, it was observed that only for 189(51.8%) cases pain assessment was done within 48h after Surgery. Out of the patient who had got pain assessment within 48h the location of pain was explained in 93(25.5%) cases, pain quality was assessed in 128(35.1%) cases, and pain intensity tool was used in 169(46.3%) cases. Weak opioid (tramadol) is the most commonly described followed by Non-steroid anti-inflammatory drugs to relieve pain after surgery. Only 16(4.4%), patient card side effect was documented and the most reported side effect was Nausea and vomiting (13(3.6%). Lack of regular clinical audits for pain management, lack of technical updates on pain assessment and management as well as knowledge and attitude of health professionals toward pain management were the major barrier to effective pain management. and recommendation: The pain assessment and documentation in the present study were slightly lower than in previous studies. There was a lack of clinical audit for pain management, a lack of refreshment/technical updates on pain assessment and management, and a lack of regulation of procurement for anti-pain medications. We recommend providing regular technical updates for health professionals and conducting a frequent clinical audit on pain management as well as a designing mechanism for easy availability of anti-paint medications, particularly strong opioids.

Clinical Policy: Critical Issues in the Sedation of Pediatric Patients in the Emergency Department