Challenges In Pain Management Research Articles

Voices of Care: Nurses' Perspectives on End-of-Life Care for Black/African American Patients.

This qualitative study examines the distinct experiences of Black/African American nurses in providing end-of-life care to patients of the same racial background and their families. It fills a significant gap in existing research by focusing on the lived experiences and perceptions of Black/African American nurses, gathered through semistructured interviews. Using phenomenological analysis with Colaizzi's method, the study identified principal themes such as racial and ethnic disparities in treatment, challenges in pain management, the need for cultural sensitivity, and the significant influence of historical Black/African American patients' mistrust in health care interactions. The findings illustrate pervasive health care disparities, which are intensified by socioeconomic variables, cultural incompetence, and systemic bias. The nurses highlighted the urgent need for enhanced cultural competence in health care practices to ensure equitable treatment and patient-centric care. This research underscores the necessity for systemic reforms to improve cultural sensitivity and trust within health care services, advocating for comprehensive cultural competency training, greater diversity in health care representation, and effective mechanisms for reporting and addressing disparities. These measures are critical for improving health care outcomes and trust among Black/African American communities at the end of life.

Minimally invasive denervation of the wrist: A cadaveric feasibility study for a single injection that targets both anterior and posterior interosseous nerves under ultrasound-guidance

BackgroundWrist osteoarthritis poses significant challenges in pain management and functional impairment. Current surgical interventions often sacrifice wrist motion and entail long recovery times. Minimally invasive denervation offers a promising alternative by targeting sensory nerves. This study investigates the efficacy of ultrasound-guided chemical ablation with phenol-glycerin for wrist denervation. MethodsUnder ultrasound guidance, 1–3 mL of 1 % methylene blue:8 % phenol:8 % glycerin solution was injected on both side of the interosseous membrane of six unembalmed cadaveric wrists. The entry point of the 22-gauge needle was along the lateral border of the ulna, just proximal to the most proximal aspect of the ulnar head. Dissections of the anterior and posterior compartment of the forearm were performed to visualize the length of both posterior interosseous (PIN) and anterior interosseous (AIN) nerves that were stained. ResultsResults showed a successful dispersion of methylene blue staining along the PIN (2.1 ± 0.82 cm), deep to the fourth extensor compartment of the wrist posteriorly, and along the AIN (2.5 ± 1.10 cm), between the interosseous membrane and pronator quadratus muscle anteriorly. Importantly, this diffusion spared the main motor branches of both nerves. CONCLUSIONS. Minimally invasive denervation of the wrist using ultrasound-guided chemical ablation with phenol-glycerin shows promise in targeting the sensory branches of both interosseous nerves.

Effect of low-dose dexmedetomidine to prolong spinal anesthesia in elderly patients: a prospective randomized controlled study.

Spinal anesthesia for transurethral resection of the prostate (TURP) has a short duration, which poses challenges for postoperative pain management. The present study aimed to investigate the effects of intravenous (IV) dexmedetomidine at a dosage of 0.4µg/kg in prolonging the duration of spinal anesthesia and minimizing postoperative pain in elderly patients undergoing TURP. This prospective randomized controlled trial enrolled 38 patients aged 60-80 years who underwent elective TURP with spinal anesthesia. The patients were randomly assigned to two treatment groups: Group D received IV 0.4µg/kg dexmedetomidine, whereas Group C received IV normal saline after spinal anesthesia administration. The primary outcome was the time to 2-dermatome regression. The 2-dermatome regression time was longer in Group D than in Group C (104.44 ± 16.97min vs. 80.63 ± 15.59min, p < 0.05). The peak sensory block levels were significantly higher in Group D [T7 (T6-T8)] than in Group C [T10 (T7-T10)] (p = 0.017). The incidence of hypotension and bradycardia and postoperative pain at 0, 6, 12, and 24h were not different between two groups. Intravenous dexmedetomidine at a dosage of 0.4µg/kg significantly prolongs the duration of spinal sensory blockade. Although postoperative analgesia was not different, it provided hemodynamic stability without increasing the side effects.

Influence of Nociception Level Monitor (NOL)-Guided Analgesic Delivery on Perioperative Course in Breast Surgeries: A Randomized Controlled Trial

Background and Objectives: Breast cancer surgeries offer challenges in perioperative pain management, especially in the presence of inherent risk of postoperative nausea and vomiting (PONV) and postmastectomy pain syndrome (PMPS). Inappropriate opioid consumption was speculated as one of the reasons. Through this study, the influence of objective pain monitoring through a nociception level monitor (NOL) on perioperative course in breast surgeries was investigated. Materials and Methods: This was a prospective randomized study conducted at a regional hospital. Sixty female patients posted for breast cancer surgery were randomized equally into study and control groups. Both groups were monitored using BIS and NOL, but in the control group, the NOL monitor was blinded by a cover. Both groups received propofol and remifentanil through target-controlled infusions (TCIs) along with interpectoral, pectoserratus (PECS II), and superficial pectointercostal block. The primary outcome was intraoperative opioid consumption. Secondary outcomes were PONV, eligibility for discharge from the recovery room, and symptoms of PMPS after three months. Results: Two patients were excluded. The study group received significantly less remifentanil (0.9 mg in the study group vs. 1.35 mg in the control group, p = 0.033) and morphine (2.5 mg in study group vs. 5 mg in control group, p = 0.013). There was no difference in PMPS symptoms between the groups. The study group showed longer duration of inadequate analgesia (i.e., 7% vs. 10% of the total intraoperative period in control and study group, respectively, p = 0.008). There was no difference in time to eligibility for discharge from the recovery room between the groups. Conclusions: NOL monitor-guided analgesic delivery reduces intraoperative opioid consumption. No difference was demonstrated on PONV, eligibility for discharge from the recovery room, or PMPS symptoms.

FLT3 signaling inhibition abrogates opioid tolerance and hyperalgesia while preserving analgesia

Navigating the duality of opioids’ potent analgesia and side effects, including tolerance and hyperalgesia, is a significant challenge in chronic pain management, often prompting hazardous dose escalation to maintain analgesic effects. The peripheral mu-opioid receptor (MOR) is known to mediate these contradictory effects. Here, we show that the fms-like tyrosine kinase receptor 3 (FLT3) in peripheral somatosensory neurons drives morphine tolerance and hyperalgesia in a male rodent model. We found that chronic morphine treatment increases FLT3 and MOR co-expression, and that inhibiting FLT3 represses MOR-induced hyperactivation of the cyclic adenosine monophosphate (cAMP) signaling pathway, mitigating maladaptive excitatory processes engaged after chronic morphine treatment. Furthermore, in postsurgical or inflammatory models of chronic pain, co-administering morphine with a FLT3-specific inhibitor not only prevents or suppresses tolerance and hyperalgesia but also potentiates the analgesic efficacy of morphine, without aggravating other morphine-induced adverse effects. Our findings suggest that pairing morphine with FLT3 inhibitors could become a promising avenue for chronic pain management to safely harness the power of opioids, without the risk of dose escalation. By enhancing morphine analgesic potency through FLT3 inhibition, this approach could minimize opioid dosage, thereby curtailing the risk of addiction and other opioid-related side effects.

Development and Validation of the Decisions to use Opioids Measure

BackgroundMillions experience inadequately managed acute pain each year. Opioids are an important tool for managing pain; however, recent reductions in opioid prescriptions have exacerbated preexisting challenges in pain management. Moreover, patient expectations and desires for pain management may drive additional opioid use. There is an important need to characterize patient motivations for using opioids in order to develop promising interventions. The aim of this study was to develop the Decisions To use Opioids (DTO) measure. MethodsWe used an exploratory sequential mixed methods design to create items for the DTO measure. Qualitative data from patient interviews and focus groups informed the development of items for the DTO. We evaluated the content validity of candidate items with nine experts using the content validity index (CVI) and conceptual significance. Face validity was assessed via cognitive interviews with five emergency department (ED) participants who experienced acute pain. ResultsWe generated an initial pool of 52 items. Expert ratings provided evidence of content validity on 40 items, as indicated by an item CVI score of 0.83 or higher. Nine items with CVI scores of <0.83 were retained and revised due to the conceptual significance. The remaining three items were discarded. ConclusionsThis study provided evidence of content and face validity of the DTO measure for ED patients. Further psychometric evaluation is needed to gather data regarding the DTO's internal consistency, construct validity, and criterion validity.

Epidural Analgesia for Palliative Pain Management for A Patient with An Advanced Stage Prostate Cancer: A Case Report

Introduction: Patients with advanced-stage cancer should be able to stay at home with their families without suffering from pain. This case report aims to discuss challenges in pain management of a patient with bone metastasis of prostate cancer who received epidural analgesia at home. Challenges were related to the patients, health professionals, and system. Understanding each factor will bring insights to develop a workable pain management program in the palliative setting. Case Presentation: A 66-year-old male was diagnosed with left sacroiliac joint pain due to metastatic prostate cancer. After a three-year history of prostate cancer and ineffective chemotherapy, the patient complained of pain in the left hip that did not improve with conventional medications (paracetamol, tramadol, and Morphine Sustained Release/MST). In response, the consideration of an epidural implant emerged as a potential solution, offering the prospect of home-based care and autonomous medication administration through an epidural continuous block with intermittent drug injection. Conclusions: This case highlights home-based interventional pain management for cancer, addressing challenges at the patient, health professional, and system level. Overcoming these challenges requires a multidisciplinary approach and robust institutional policies. The insights gained offer valuable lessons for hospitals aiming to enhance the competence of pain and palliative care teams and establish comprehensive support systems in hospital and home settings.

Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries.

Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia. A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed. The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant (p-value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant (p-value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups. Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management.

“Straight from the Horse’s Mouth”: Equine-Assisted Services Curriculum Development Using Industry-Based Survey Assessment of Horse Welfare and Healthcare Management Practices

Equine-assisted services (EAS) is a relatively new area of study within higher education requiring the development of a curriculum that best prepares the undergraduate student for the demands of the industry. Further, coursework targeting the specific management challenges for ensuring the welfare of horses utilized within EAS is limited. Therefore, the objective of this study was to apply an industry-based survey assessment utilizing EAS professionals within the United States to document management practices associated with healthcare and pain management challenges in the EAS horse. Suggested curriculum for undergraduate students targeting a career in EAS is given, utilizing data collected from the survey. Participant responses (n = 30) indicated that all of the surveyed facilities cared for more than three geriatric horses within their program, with the majority (60% responding “definitely yes”) utilizing regularly functionally lame horses, although the prevalence of lameness was not correlated with number of geriatric horses within a program (0.20, p = 0.22). While lameness is a common healthcare challenge within EAS, gastrointestinal conditions (73%) were one of the other leading health concerns for these facilities. The most common equine pain detection method for EAS facilities was behavior assessment (93%), in which this method was positively correlated with years of horse experience (0.51, p = 0.01). Horse pain was primarily managed through annual alternative therapeutic interventions (76%), daily prescriptions (73%), and nutritional supplements (73%). As such, the curriculum for undergraduate EAS degree programs should cover healthcare practices targeting geriatric horse management and associated health issues such as gastrointestinal conditions and lameness, including early detection and pharmaceutical, nutritional, and alternative therapeutic treatments.

Overcoming Barriers: A Comprehensive Review of Chronic Pain Management and Accessibility Challenges in Rural America.

In the United States (U.S.), chronic pain poses substantial challenges in rural areas where access to effective pain management can be limited. Our literature review examines chronic pain management in rural U.S. settings, identifying key issues and disparities. A comprehensive search of PubMed, Web of Science, and Google Scholar identified high-quality studies published between 2000 and 2024 on chronic pain management in the rural U.S. Data were categorized into thematic areas, including epidemiology, management challenges, current strategies, research gaps, and future directions. Key findings reveal that rural populations have a significantly higher prevalence of chronic pain and are more likely to experience severe pain. Economic and systemic barriers include a shortage of pain specialists, limited access to nonpharmacologic treatments, and inadequate insurance coverage. Rural patients are also less likely to engage in beneficial modalities like physical therapy and psychological support due to geographic isolation. Additionally, rural healthcare providers more often fulfill multiple medical roles, leading to burnout and decreased quality of care. Innovative approaches such as telehealth and integrated care models show the potential to improve access and outcomes. Our review highlights the need for increased telehealth utilization, enhanced provider education, and targeted interventions to address the specific pain needs of rural populations.

Evaluating Large Language Models in Dental Anesthesiology: A Comparative Analysis of ChatGPT-4, Claude 3 Opus, and Gemini 1.0 on the Japanese Dental Society of Anesthesiology Board Certification Exam.

Purpose Large language models (LLMs) are increasingly employed across various fields, including medicine and dentistry. In the field of dental anesthesiology, LLM is expected to enhance the efficiency of information gathering, patient outcomes, and education. This study evaluates the performance of different LLMs in answering questions from the Japanese Dental Society of Anesthesiology Board Certification Examination (JDSABCE) to determine their utility in dental anesthesiology. Methods The study assessed three LLMs, ChatGPT-4 (OpenAI, San Francisco, California, United States), Gemini 1.0 (Google, Mountain View, California, United States), and Claude 3 Opus (Anthropic, San Francisco, California, United States), using multiple-choice questions from the 2020 to 2022 JDSABCE exams. Each LLM answered these questions three times. The study excluded questions involving figures or deemed inappropriate. The primary outcome was the accuracy rate of each LLM, with secondary analysis focusing on six subgroups: (1) basic physiology necessary for general anesthesia, (2) local anesthesia, (3) sedation and general anesthesia, (4) diseases and patient management methods that pose challenges in systemic management, (5) pain management, and (6) shock and cardiopulmonary resuscitation. Statistical analysis was performed using one-way ANOVA with Dunnett's multiple comparisons, with a significance threshold of p<0.05. Results ChatGPT-4 achieved a correct answer rate of 51.2% (95% CI: 42.78-60.56, p=0.003) and Claude 3 Opus 47.4% (95% CI: 43.45-51.44, p<0.001), both significantly higher than Gemini 1.0, which had a rate of 30.3% (95% CI: 26.53-34.14). In subgroup analyses, ChatGPT-4 and Claude 3 Opus demonstrated superior performance in basic physiology, sedation and general anesthesia, and systemic management challenges compared to Gemini 1.0. Notably, ChatGPT-4 excelled in questions related to systemic management (62.5%) and Claude 3 Opus in pain management (61.53%). Conclusions ChatGPT-4 and Claude 3 Opus exhibit potential for use in dental anesthesiology, outperforming Gemini 1.0. However, their current accuracy rates are insufficient for reliable clinical use.These findings have significant implications for dental anesthesiology practice and education, including educational support, clinical decision support, and continuing education. To enhance LLM utility in dental anesthesiology, it is crucial to increase the availability of high-quality information online and refine prompt engineering to better guide LLM responses.

Postoperative Multimodal Approach to Pain Control in Anterior Cruciate Ligament Autograft Surgery: A Single-Center Series

Background: Anterior cruciate ligament (ACL) injuries are prevalent and represent a significant socioeconomic burden, as ACL injuries account for nearly 60% of all knees joint traumas. The purpose of this study is to emphasize the role of arthroscopic ACL reconstruction and the challenges in postoperative pain management. Methods: This study involved 90 patients undergoing ACL reconstruction, categorized into three groups receiving different pain management protocols. The focus was on evaluating the efficacy of multimodal analgesia using lidocaine and magnesium sulfate. The main outcome was pain assessment using the Visual Analog Scale (VAS). Results: Patients receiving fentanyl, lidocaine, and magnesium sulfate (FLM) reported significantly lower pain scores in the postoperative period. Minimal use of additional opioids was observed, suggesting effective pain management with the multimodal analgesia regimen. Conclusions: The study showed that multimodal analgesia, including FLM, effectively manages postoperative pain following ACL reconstruction. This study showed significantly lower pain scores with FLM, highlighting its potential in early postoperative pain relief. Future research should consider long-term outcomes and cost-effectiveness, emphasizing the need for more comprehensive evaluations of multimodal analgesia’s impact.

Opioid and benzodiazepine requirements in critically ill post-surgical children with down syndrome: a systematic review and meta-analysis

BackgroundDown syndrome (DS), or Trisomy 21, is defined by the existence of an additional chromosome 21. Various physiological considerations in DS patients might lead to challenges in adequate pain management and sedation after surgery. The aim of this systematic review and meta-analysis is to evaluate the variations of the requirement needed for pain management and sedation in patients with DS who have undergone surgery compared to patients without DS.MethodsA systematic review and meta-analysis of studies were conducted, focusing on critically ill patients with DS who were admitted to Intensive care units (ICUs) post-surgery and received opioids and/or benzodiazepines. Searches were conducted in four databases from their inception to November 18, 2023 (Pubmed, Scopus, Cochrane Library, and Web of Science). The primary outcome measured was the dosage of Oral Morphine Equivalent (OME) administered in the days following surgery. Fixed-effect models were used, an approach advisable when only a limited number of studies are available.Results Out of the 992 studies initially screened, the systematic review included ten studies, encompassing 730 patients, while the meta-analysis consisted of seven studies, encompassing 533 patients. Of the seven studies included in the analysis, 298 patients were identified to have DS, and 235 patients served as controls. Patients with DS showed a slight increase in OME needs on the first day, but this increase was not statistically significant (mean difference [MD] = 0.09; 95% Confidence Interval [CI]: [-0.02, 0.20]; P = 0.11). There was also no significant difference in the requirement for Midazolam on the first day among DS patients (MD = 0.01; CI [-0.16, 0.19]; P = 0.88). In addition, the duration of mechanical ventilation was not statistically significant in patients with DS compared with the control group (MD = -1.46 hours; 95% CI [-9.74, 6.82]; P = 0.73).ConclusionPatients with Down syndrome did not require more sedation or analgesia in the first three days after surgery than patients without Down syndrome. Additionally, the two groups showed no significant difference in the duration of mechanical ventilation.

Assessment of first-time attendees at a pain clinic using a pain inventory tool

Aims: Pain presents a complex challenge affecting the quality of life of over a million adults annually. Understanding the variety and distribution of pain types is vital for effective management and intervention strategies. This study aimed to assess the characteristics and distribution of pain among first-time attendees at a pain clinic using the Brief pain inventory (BPI). Methods: A cross-sectional survey was conducted with 100 adult outpatients at the pain clinic of the İstanbul Training and Research Hospital from July to November 2012. The BPI was administered face-to-face and demographic data were collected. Individuals under 18 years of age, mentally retarded, previous pain clinic attendance, cancer pain, or diagnosed rheumatic diseases was excluded. Written informed consent was obtained from all participants. Descriptive statistics were used to describe the means, standard deviations, and frequency distributions. Results: The study included 100 adult patients with a mean age of 46.4, predominantly female (65%), who sought treatment for various pain complaints at a pain clinic. The majority reported throbbing (41% knee, 31% lumbar, and 65% shoulder) and exhausting pain (74% knee, 73% lumbar, and 65% shoulder), with significant proportions experiencing constant pain, especially in the knee (82%) and lumbar region (81%). Regular analgesic use was noted in 54% of the patients, with 65% requiring daily medication, indicating high demand for pain management. Despite treatment, 90% expressed the need for stronger pain relief and 50% reported side effects from analgesics. Various nonpharmacological methods have been used, such as hot compression (38%) and relaxation techniques (30%). Conclusion: The study reveals the significant pain burden among first-time pain clinic patients, with throbbing and exhausting sensations prevalent in knee and lumbar regions. The extensive use of analgesics and need for stronger pain relief indicate ongoing pain management challenges. The adoption of nonpharmacological methods highlights the need for a multifaceted approach. These findings emphasize the necessity of tailored, multidimensional pain management strategies for enhanced patient care and quality of life.

Improving door-to-analgesia timing in musculoskeletal injuries in an academic emergency department in India: a quality improvement project

IntroductionPain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many...

Unraveling the Potential of Electroanalgesia: A Literature Review of Current Therapeutics.

Neuropathic pain (NP), arising from dysfunction in the neurological system, poses a significant challenge in pain management due to its intricate origin and unpredictable response to conventional treatments. Electroanalgesia, a collection of techniques such as transcutaneous electric nerve stimulation (TENS), peripheral electrical nerve stimulation (PENS), spinal cord stimulation (SCS), deep brain stimulation (DBS), and electroacupuncture (EA), presents a potential alternative or complementary approach. This review brings together evidence from 56 studies to evaluate the effectiveness and safety of electroanalgesia in chronic NP. It discusses the mechanisms underlying NP, the indications for electroanalgesia, and the techniques utilized, emphasizing the diverse applications and potential benefits. However, despite its potential uses, electroanalgesia has its limitations, including variable effectiveness and potential adverse effects. Furthermore, the review recognizes the limitations of the methodology and the need for further research to refine treatment protocols and enhance the understanding of electroanalgesia's role in comprehensive pain management strategies.

Impact of Intraoperative Nefopam on Postoperative Pain, Opioid Use, and Recovery Quality with Parietal Pain Block in Single-Port Robotic Cholecystectomy: A Prospective Randomized Controlled Trial.

Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials and Methods: Forty patients scheduled for elective single-port RALC were enrolled and randomized to receive either nefopam or normal saline intravenously. Parietal pain relief was provided through a rectus sheath block (RSB). Postoperative pain was assessed using a numeric rating scale (NRS) in the right upper quadrant (RUQ) of the abdomen, at the umbilicus, and at the shoulder. Opioid consumption and recovery quality, measured using the QoR-15K questionnaire, were also recorded. Results: The 40 patients had a mean age of 48.3 years and an average body mass index (BMI) of 26.2 kg/m2. There were no significant differences in the pre- or intraoperative variables between groups. Patients receiving nefopam reported significantly lower RUQ pain scores compared to the controls, while the umbilicus and shoulder pain scores were similar. Rescue fentanyl requirements were lower in the nefopam group in both the PACU and ward. The QoR-15K questionnaire scores for nausea and vomiting were better in the nefopam group, but the overall recovery quality scores were comparable between the groups. Conclusions: Nefopam reduces RUQ pain and opioid use post-single-port RALC with a parietal pain block without markedly boosting RSB's effect on umbilicus or shoulder pain. It may also better manage postoperative nausea and vomiting, underscoring its role in analgesia strategies for this surgery.

Establishing Geriatric Opiate Use Patterns in Trauma.

Introduction: There is evidence that providers often overprescribe opiates in the postoperative period. Despite an ever-growing geriatric population, there is little research detailing current opiate usage in older patients after trauma. This population presents a unique set of challenges for pain management and prescription drug dependence due to sensitivity, a narrow therapeutic window, and high rates of pre-existing polypharmacy.Objective: Assess the use of narcotics in geriatric trauma patients with various injury patterns to establish a reference point for future intervention for reduction in narcotic dependence.Methods: We created a database of trauma patients' age ≥65 years admitted to a single level 1 trauma center in the Southeastern United States during the 2019 calendar year. Information gathered included patient factors, injury patterns, operative intervention, pain medications prescribed during hospitalization and at discharge, total and average daily morphine milligram equivalents (MME) inpatient and outpatient, and requests/prescriptions for narcotics at follow-up.Results: In 2019, there were 475 patients aged ≥65 admitted to our level 1 trauma center for acute traumatic injuries. 219 of those patients required operative intervention. Average total inpatient MME for this cohort was 169.0 with average daily MME of 22.89. The average total prescribed MME upon discharge was 79.27. There were 29 patients documented to request narcotic prescription refill at time of clinic follow-up, 27 of whom were prescribed a narcotic medication at follow-up.Conclusion: This dataset establishes a reference point for opiate use in geriatric trauma patients to facilitate further research for mitigation of risk in this population.

Chronic pain healthcare workers’ challenges in pain management and receptiveness towards VR as an adjunct management tool: a qualitative study

Abstract Background Chronic pain is often a debilitating condition that affects individuals physically and mentally. Reliance on pharmacotherapy for pain management comes with risks of analgesic misuse and dependence. Hence, non-pharmacologic treatment plays a crucial role in pain management. Virtual reality is a novel method in chronic pain management. However, there is little understanding about healthcare providers’ perspectives on the use of virtual reality technology in managing chronic pain. This study aims to explore the current management challenges faced by chronic pain healthcare providers and their perspectives on using virtual reality as adjunctive therapy in managing chronic pain. Method Individual semi-structured interviews were conducted among all chronic pain healthcare providers in a tertiary hospital. The interviews were analysed using qualitative thematic analysis. Results Eight chronic pain healthcare providers participated in this study. Financial issues were cited as one of the biggest barriers to utilisation of non-pharmacological treatment. Participants highlighted the importance of psychosocial support from family and healthcare providers. Challenges identified included absence of patient engagement and lack of awareness about pain management among healthcare providers as well as the lack of an integrated multidisciplinary approach in our healthcare system. Participants were receptive towards the use of virtual reality in chronic pain management and offered ample opinions and suggestions for its application in chronic pain management. Conclusions A multilevel, multifaceted approach is needed to improve chronic pain management. Virtual reality technology could be considered as an adjunct therapy to address some of the challenges and limitations identified in this study.

A Qualitative Exploration of Rural Older Adults' Experiences With Pain From Chronic Illnesses and Its Treatment.

Pain is one of the most common concerns among chronically ill older adults. However, access to pain management is not equitable among certain populations, including rural residents. This qualitative study explored rural older adults' experiences with pain and its treatment. Eighteen participants were recruited from rural counties of Alabama, who were age 60+, cognitively intact, community-dwelling, had one or more chronic/serious illnesses, and experienced pain. Open-ended questions were asked in individual interviews, and inductive, thematic analysis was used for data analysis. Findings revealed the impact of pain (physical limitations, psychological distress, and coping strategies), the impact of COVID-19 (physical/mental health and pain management), challenges in pain management in rural areas (lack of provider and healthcare resources, transportation-related issues, mistrust, and limited insurance coverage) and suggestions to address these challenges. Program and policy-level interventions are crucial in improving the resources and education/training needed for effective pain management for rural older adults.