Initial Pain Assessment Research Articles

Bridging the pain gap after cancer surgery - Evaluating the feasibility of transitional pain service to prevent persistent postsurgical pain - A systematic review and meta-analysis.

The lack of a dedicated pain service catering to the postsurgical period has resulted in the origination of the pain-period gap. This has led to a resurgence of transitional pain service (TPS). Our objective was to evaluate the feasibility of TPS in pain practice among postsurgical cancer patients and its prevention of persistent postsurgical pain (PPSP), culminating in chronic pain catastrophising. The protocol for this meta-analysis was registered in the International Prospective Register of Systematic Reviews (ID: CRD42023407190). This systematic review included articles involving all adult cancer patients undergoing cancer-related surgery experiencing pain, involving pharmacological, non-pharmacological and interventional pain modalities after an initial systematic pain assessment by pain care providers across diverse clinical specialities, targeting multimodal integrative pain management. Meta-analysis with meta-regression was conducted to analyse the feasibility of TPS with individual subgroup analysis and its relation to pain-related patient outcomes. Three hundred seventy-four articles were evaluated, of which 14 manuscripts were included in the meta-analysis. The lack of randomised controlled trials evaluating the efficacy of TPS in preventing PPSP and pain catastrophising led to the analysis of its feasibility by meta-regression. The estimate among study variances τ2 was determined and carried out along with multivariate subgroup analysis. A regression coefficient was attained to establish the correlation between the feasibility of TPS and its patient outcome measures and opioid-sparing. TPS interventions carried out by multidisciplinary teams incorporating bio-physical-psychological pain interventions have resulted in its successful implementation with improved pain-related patient outcomes mitigating the occurrence of PPSP.

Randomized Clinical Trial: Bone Bioactive Liquid Improves Implant Stability and Osseointegration.

Implant stability can be compromised by factors such as inadequate bone quality and infection, leading to potential implant failure. Ensuring implant stability and longevity is crucial for patient satisfaction and quality of life. In this multicenter, randomized, double-blind clinical trial, we assessed the impact of a bone bioactive liquid (BBL) on the Galaxy TS implant's performance, stability, and osseointegration. We evaluated the impact stability, osseointegration, and pain levels using initial stability quotient (ISQ) measurements, CBCT scans, and pain assessment post-surgery. Surface analysis was performed using scanning electron microscopy (SEM) and atomic force microscopy (AFM). In vitro studies examined the BBL's effects on dental pulp pluripotent stem cells' (DPPSCs') osteogenesis and inflammation modulation in human macrophages. All implants successfully osseointegrated, as demonstrated by the results of our clinical and histological studies. The BBL-treated implants showed significantly lower pain scores by day 7 (p < 0.00001) and improved stability by day 30 (ISQ > 62.00 ± 0.59, p < 8 × 10-7). By day 60, CBCT scans revealed an increased bone area ratio in BBL-treated implants. AFM images demonstrated the BBL's softening and wettability effect on implant surfaces. Furthermore, the BBL promoted DPPSCs' osteogenesis and modulated inflammatory markers in human primary macrophages. This study presents compelling clinical and biological evidence that BBL treatment improves Galaxy TS implant stability, reduces pain, and enhances bone formation, possibly through surface tension modulation and immunomodulatory effects. This advancement holds promise for enhancing patient outcomes and implant longevity.

Study to determine the efficacy and onset of Bonipar, a topical analgesic for the management of acute and chronic musculoskeletal pain

BackgroundOpioid abuse and mortality are ravaging American society, highlighting the need to find alternative effective analgesics with fewer side effects. FDA-approved topical analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), are commonly used to treat musculoskeletal pain but can cause adverse effects. Natural compounds, including essential oils, are potential therapeutic alternatives for managing musculoskeletal pain. If these compounds can provide comparable analgesia to FDA-approved products, it will increase the available options for people with pain, improving quality of life with minimal morbidity and mortality. ObjectiveThis study assesses the effectiveness and onset of action of Bonipar, a topical analgesic formulated with camphor, methyl salicylate, and oils of coconut, eucalyptus, nutmeg, and rosemary, in managing musculoskeletal pain compared to 1.5 % diclofenac solution, an FDA-approved topical non-steroidal anti-inflammatory drug. MethodsOne hundred sixty-four adult patients with localized musculoskeletal pain were randomly assigned to twice-daily applications of either Bonipar or Diclofenac for one week. The primary outcome measure was a 50 % reduction in pain after one week. Secondary outcomes included the change in pain from baseline and onset of action, defined as the first reduction in pain by 20 %. ResultsAll patients completed the initial pain assessment to determine the onset of action. One-week data was available for 74 patients treated with diclofenac and 72 patients treated with Bonipar. Data for 18 patients were incomplete. The proportion of patients achieving a 50 % reduction in pain was statistically similar between the two groups. The success rates of achieving a 50 % pain reduction with Bonipar were found to be non-inferior to those treated with diclofenac. All follow-up time points showed roughly similar results between the groups. Regression models adjusted for age and sex revealed no significant effects on pain changes. Secondary analyses demonstrated no significant differences between the groups. DiscussionThe topical analgesic Bonipar demonstrates a comparable onset of action, with efficacy non-inferior to diclofenac in the management of musculoskeletal pain, while showing fewer adverse effects compared to diclofenac. These findings highlight the potential of Bonipar as a valuable alternative for the treatment of localized pain.

A Study of High-Resolution Ultrasound and Magnetic Resonance Imaging Findings in Shoulder Joint Pain at a Tertiary Care Hospital in Central India.

Objective This study aims to investigate the diagnostic efficacy of high-resolution ultrasound (USG) and magnetic resonance imaging (MRI) in patients with shoulder joint pain at a tertiary care hospital in Central India. Methods This cross-sectional study was conducted at Acharya Vinoba Bhave Rural Hospital from 2021 to 2024. The study population consisted of patients with shoulder pain, without fractures, who were evaluated using USG and MRI. Participants with infective arthritis, rheumatoid arthritis, previous shoulder surgery, or contraindications for MRI were excluded. Data were recorded and analyzed using Microsoft Excel (Microsoft Corporation, Redmond, Washington) and R 4.2.0 software (The R Foundation, Vienna, Austria). Sensitivity, specificity, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of USG and MRI. Results A total of 80 patients were included, with 49 (61%) males and 31 (39%) females. The MRI findings showed supraspinatus partial tears in 44 (55%) cases, complete tears in 10 (12.5%), and various other shoulder pathologies. USG detected supraspinatus partial tears in 16 (19.5%) and complete tears in seven (8.8%). Kappa statistics indicated moderate to high agreement between USG and MRI for several pathologies, with near-perfect agreement for complete tears. Conclusion High-resolution USG is a valuable tool for the initial assessment of shoulder joint pain, providing reliable diagnostic information with high agreement levels with MRI for complete tears and certain shoulder conditions. MRI remains indispensable for comprehensive evaluation, particularly for partial tears and complex pathologies.

Fracture pain in children in the emergency department: the impact of a new pain management procedure

PurposeTo compare compliance with the French national guidelines before and after the implementation (in 2018) of a new protocol on acute fracture pain management in the pediatric emergency department of a French university medical center.MethodsWe conducted a retrospective, before-after study in patients aged below 16 years presenting at the pediatric emergency department with a fracture. We compared pain management before (in 2017) and after (in 2019 and 2020) implementation of the new procedure. The primary endpoint was appropriate pain management, defined as (i) an appropriate initial assessment of pain, (ii) appropriate treatment with analgesic drugs (acetaminophen for mild pain, acetaminophen and ibuprofen for moderate pain, ibuprofen and morphine for severe pain) and (iii) reassessment of the pain intensity.Results572 patients were included (mean age: 6.5 years; male: 60%). 190 in 2017 and 382 in 2019–2020. Pain management was appropriate for 40% of the patients in 2017 and 52% in 2019–2020 (p = 0.004). Pain was rated for 98% of patients in 2017 vs. 100% in 2019–2020 (p = 0.04). The frequency of appropriate treatment for mild pain and moderate pain increased significantly from 52 to 76% and from 0 to 44%, respectively. The administration of ibuprofen increased by 26% points (from 3 to 20 patients treated) and the administration of morphine increased by 29% points (from 1 to 17 patients treated). Pain reassessment rose significantly from 21 to 43%. Levels of compliance with the guidelines were similar in 2019 and 2020. Analgesia was significantly more effective in 2019–2020 than in 2017 (in 20% vs. 14% of the patients, respectively; p = 0.005).ConclusionAfter the implementation of a new protocol for the management of acute fracture pain, we observed an increase in compliance with the guidelines. Although the use of ibuprofen and morphine rose significantly as did the frequency of pain reassessment, further improvements are required.

Typical and atypical chest pain: an equivocal and dangerous definition

Abstract Background The traditional classification of stable chest pain into typical, atypical and non anginal1 is equivocal and can lead to doctor's decisions and patient's perception that do not correspond to the real importance of the clinical picture. Methods In the last 15 years, 3,588 outpatients, aged &amp;gt;35 years (mean 64±9, female 55%) were evaluated for stable chest pain reported for more than 48 hours. We excluded 290 patients with a history of myocardial infarction or angina pectoris, heart failure, valve diseases or any other major cardiovascular event, or ECG signs of recent ischemia. In the other 3,298 cases we applied the traditional classification of chest pain. All patients were evaluated for the presence of HEART score risk factors² (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non-anginal pain according to the physician's judgment were evaluated with one or more functional cardiovascular tests (exertion test, nuclear stress tests, stress echo).A follow-up was performed at 6 months and 1 year, for the detection of major cardiovascular events (cardiovascular death, non-fatal heart attack, revascularization, stroke) and non-cardiovascular mortality. Results Table 1 shows the results of chest pain classification and positive functional test. Table 2 shows major events at one year of follow-up stratified according to the initial assessment of chest pain. Table 3 stratifies the events according to the extent of the risk factors and age. It is evident that a positive functional test is also present in 10% of patients with atypical pain and in 4% of those with non-anginal pain. Patients with typical pain undergo revascularization more frequently (39%). The peculiarity of our study is that the prognosis and rate of events do not differ in terms of clinical and ischemic burden among the 3 groups at 1 year of follow-up, except when patients are stratified by risk burden and for age (Table 4). About 1% of patients had a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. Nine percent of all heavy smokers aged &amp;lt;65 years had a major event and are the highest risk group with a peak of 12.5% in those with atypical pain. Conclusions The traditional classification of stable chest pain should be abandoned, as it does not correlate with actual disease burden and prognosis, that appears to be linked to the burden of cardiovascular risk and above all to smoking in patients &amp;lt; 65 years of age, rather than to the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search of high-risk coronary lesions improves the prognosis with added value with respect to the treatment of risk factors³.Picture 1Picture 2

Design and Development of A web-based Chronic Pain Registry System

Introduction: Chronic pain is a significant clinical problem in the world. No treatment is quite effective for chronic pain due to its complex nature. However timely retrieval of accurate and comprehensive information through organized clinical and epidemiological studies is an essential prerequisite for providing high-quality clinical care and more accurate health care planning. This can be achieved by the creation of an electronic registry system as a strong source of information. The purpose of this study was to develop and evaluate a chronic pain registry for patients with chronic pain syndromes.Material and Methods: In the current study, Onion architecture with the MVC design pattern was selected in design phase. Using onion architecture leads to more flexible and reusable codes and results in easier development and maintenance. In the development phase, MYSQL DBMS and the PHP programming language, which are suitable for developing the web-based system, were used.Results: The minimum data set was determined in the previous study. This dataset covered six areas: demographic information, initial pain assessment, medical history, mental health and well-being, diagnostic measures, and diagnosis and treatment plan. A web-based pain registry system was developed based on the minimum data set.Conclusion: There are many studies for development of web- based pain registries in the world but there is a few information about technical architecture and structure in design phase. In current study, we focused on the technical architecture design of system. Using onion architecture leads to more flexible and reusable codes and results in easier development and maintenance. In the current study, it was chosen to use MYSQL and the PHP programming language, which is suitable for developing the web-based system. Finally, a web-based registry system was developed to store and report on the information of patients suffering from chronic pain. It can manage and control chronic pain and facilitate future research.

P63 THE EQUIVOCAL AND DANGEROUS CLASSIFICATION OF STABLE CHEST PAIN

Abstract Background The classification of suspected anginal stable chest pain into typical, atypical, and non anginal is equivocal and may lead to patient perceptions and physician decisions that do not match the importance of the clinical picture. The study compares the clinical and ischemic burden with that of the cardiovascular risk. Methods Over 15 years, 3588 outpatients, &amp;gt;35 years old (mean 64±9, female 55%) were evaluated for stable chest pain. 290 patients with findings indicative of ischemic heart disease, heart failure, cardiomyopathy, valvular disease were excluded. In the others we applied the classification of typical, atypical and nonanginal pain (Table 1). All were evaluated for the presence of HEART score risk factors (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non–anginal pain according to the doctor‘s judgment performed functional tests to search for ischemia. Results In Table 2 we find the results of the classification of chest pain and the positivity of the functional test. In Table 3 we have the major events at follow–up stratified according to the initial assessment of chest pain. Table 4 stratifies events according to risk factors and age. Prognosis and event rate differ significantly only when stratified by risk factors and age. Approximately 1% presented a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. 9% of heavy smokers aged &amp;lt;65 years had a major event and are the highest risk group with a peak of 12.5% ​​in those with atypical pain. Conclusions The traditional classification of stable chest pain is dangerous and misleading, both for the identification of ischemia and prognosis, which appears to be linked to the burden of cardiovascular risk and above all to cigarette smoking in patients aged &amp;lt;65 years, rather than the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search for high–risk coronary lesions improves the prognosis with an added value with respect to the treatment of lifestyles and risk factors.

Nurse-led Tele-Collaborative Pain Care for Rural Patients with Substance Use Disorder

PurposeRates of chronic non-cancer pain in patients with substance use disorders (SUD) are higher than in patients without SUD. Yet access to evidence-based pain treatment for patients with SUD is limited, particularly in rural areas where care access is often poor. The purpose of this study was to examine feasibility and preliminary efficacy of a nurse-led collaborative pain intervention for patients with comorbid chronic pain and SUD, delivered exclusively via telehealth. MethodsSubjects were 62 patients with chronic musculoskeletal pain enrolled in specialty SUD treatment at a single VA medical center and residing in rural geographic regions. Subjects received an initial pain assessment and treatment recommendations, 6 follow-up appointments over four months, and a 10-session weekly pain education class. All clinical encounters were delivered via video conference or telephone, based on patient preference and internet availability. Subjects completed an interviewer administered survey at baseline, 1- and 4-month follow-up that assessed pain severity and interference as measured by the Brief Pain Inventory, depression symptoms as measured by the Beck Depression Inventory-II, and daily substance use outcomes as measured by the Timeline Followback. ResultsPatients on average were 48 years old, and the majority were male (86%) and White Non-Hispanic (91%). By 4-month follow-up, pain severity (B = -0.67 [-1.05, -0.29]), pain interference (B = -0.94 [-1.50, -0.39]), and depression symptoms (B = -4.30 [-7.96, -0.63]) had significantly declined from baseline. A significant reduction in days of alcohol (OR = 0.64 [0.46, 0.90]) and cannabis use (OR = 0.47 [0.34, 0.66]) was also observed at 4-month follow-up. ConclusionPreliminary analyses show promise for synchronous telehealth collaborative pain interventions delivered to rural patients receiving SUD treatment, with particular benefit in reducing pain, depression symptoms, and alcohol and cannabis use.

Initial Pain Assessment and Management in Pediatric Burn Patients Presenting to a Major Trauma Center in Saudi Arabia.

Pediatric burn injury is a traumatic experience for affected children and their families. Burn pain is frequently undertreated and may adversely affect patient experience and outcomes. The aim of this study was to investigate the current practice of initial pediatric burn pain assessment and management at a major trauma center in Riyadh, Kingdom of Saudi Arabia. We conducted a retrospective cohort study that included children 14 years and younger who visited King Saud Medical City in the Kingdom of Saudi Arabia with a presenting complaint of burn injury from January 01, 2017 to August 30, 2018. Variables were reported using descriptive statistics as appropriate. The 309 patients who were analyzed were classified into 3 age groups ranging from 0 to younger than 3 years (61%), 3 to 7 years (24%), and older than 7 years (15%). They included 145 (47%) female and 164 (53%) male patients. Pain levels of 182 patients (59%) were documented using an age-appropriate tool. In 75 children (24%), pain levels were documented using an alternate tool, and the tool used was not defined for 44 children (14%). Pain assessment was not documented for 8 children. Of those with an age-appropriate tool, the median initial pain score was 4 (interquartile range [IQR], 2-4). Analgesia was recorded to have been administered to 139 patients (45%), within a median time of 50 minutes (IQR, 17-154 minutes) to first analgesia. Among patients who had appropriate assessment of pain, 92 (50.3%) received analgesia compared with 52 (41.3%) who did not have appropriate assessment (P = 0.12). Among patients who had appropriate pain assessment, time to analgesia was 42 minutes (IQR, 15-132 minutes) compared with 53 minutes (IQR, 17-189 minutes) among patients who did not have appropriate assessment (P = 0.48). Most pediatric patients presenting with burns had pain assessment, but a substantial proportion of children were not managed using recommended age-specific tools. The use of age-specific tools was not necessarily associated with delivery of analgesia. For pediatric burns, prompt delivery of analgesia should be prioritized with pain assessment using age-appropriate tools being recommended, but optional.

Algorithm-based pain management for people with dementia in nursing homes.

Algorithm-based pain management for people with dementia in nursing homes.

Pain management in children and young adults with minor injury in emergency departments in the UK and Ireland: a PERUKI service evaluation

BackgroundManagement of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland...

Pain Assessment and Documentation for Older Adults Presenting with Non-surgical Conditions in Emergency Room

Pain is one of the most common reasons for Emergency Department (ED) visits among older adults. However, timely pain assessment and management in this population in ED is a challenging task due to many factors ranging from; sensory, cognitive impairments, chronic pain, reliability of assessment tools, multimorbidity and system factors such as triage-based dynamic ED workflow. Where the implementation of the EMR was anticipated to improve patientcare, literature has indicated the barriers in effective utilization of the EMR for this purpose. We posit that pain assessment and documentation could be variable among older adults presenting with non-surgical conditions. Objectives:1. To examine the proportion of documented initial pain assessment of nonsurgical older adults visiting emergency department 2. To examine the number of initial pain assessments documented in the chart by the five major categories of ICD-10 diagnoses upon discharge. Methods: A retrospective exploratory chart review of 4613 emergency room visits for first pain assessment in the EMR conducted for all adults 65 years or older, presenting with non-surgical conditions, who were discharged same day at an urban teaching hospital. Results: In our study 75.72% of encounters reviewed had a documented pain assessment. Completed pain assessments for the corresponding five most common non-surgical diagnostic categories presenting to our ED: Abdominal pain (92.59%), MSK (92.11 %), chest pain (83.92%), dyspnea (80%) and falls (79.46%). Conclusion: Frequency of pain assessment and the management process of older adults presenting with non-surgical conditions in the institution studied was variable and differed based on presenting conditions.

Analysis of Pain Manifestation and Its Management in Adults

Introduction: Pain is link with significant disable due mobility, avoidance of activity, falls, depression and anxiety, sleep impairment, and isolation.&#x0D; Objectives: The main objective of the study is to clinically analyse the pain manifestation and its management in adults.&#x0D; Methods: This cross sectional clinical audit was done in Services hospital Lahore during January 2020 till June 2020. The data was collected from a large number of patients undergoing intermediate to major surgery and thus have high analgesic requirements. Medical folders that were not available or had missing notes were excluded. The folders were requested from the Medical Records Department and reviewed by four investigators.&#x0D; Results: The data was collected from 169 patients. The mean age of the patients was 38 years. Pain was assessed in 85 of the 168 patients (51%) (62 of the 110 urogynaecology patients; 23 of the 58 orthopaedic patients) and reassessed in 55 of the 85 patients (65%) who had received an initial pain assessment. The ward doctor (intern, registrar or specialist) assessed pain in 67% of the 85 patients evaluated.&#x0D; Conclusion: It is concluded that a significant proportion of the pain interventions appeared to be based on the professional knowledge of the practitioner and not supported by evidence-based guidelines of pain management.

Considerations on out-of-hospital pain assessment of a diverse population

Nearly all medical emergency calls are related to someone experiencing some form of discomfort—either due to trauma or pain. Initial pain assessment may be undertaken over the telephone by an emergency medical dispatcher, without seeing the patient; however, the next key moment in pain assessment is completed patient-side by the paramedic. This inquiry is detailed and guides the paramedic in the formation of a differential diagnosis and provision of appropriate pain management. The research team recently conducted and published a study on pain assessment which raised concerns on the subjectivity of pain scoring. The work presented was in the context of a very multicultural environment. The aim of this commentary article is to further explore this topic and encourage health professionals to reflect on this aspect of patient assessment.

Effect of Continuing Nursing Education on the Quality of Nursing Management of Cancer Pain in China.

Limited knowledge and poor attitudes toward pain are major barriers to nursing management of cancer pain. This study investigated the effect of continuing nursing education (CNE) on the management of cancer pain. Annual CNE was provided from 2016 to 2019, and evaluation of nursing management of cancer pain was conducted every 2 years. The effect of CNE was determined based on the evaluation results. After annual CNE, the participating hospitals showed significant improvement in nursing management of cancer pain. Annual CNE significantly increased subscores in all domains except the domain of initial pain assessment. In terms of hospital levels, nursing management of cancer pain was significantly improved only for tertiary A hospitals. Annual CNE significantly improved nursing management of cancer pain. [J Contin Educ Nurs. 2021;52(11):535-540.].

Delivering NICE Joint Pain Advice in the workplace.

BackgroundChronic joint pain is extremely prevalent, but its impact can be mitigated if people receive self‐management/lifestyle advice, especially about the importance of physical activity and maintaining a healthy weight. To reach the large number of people who needs support, we devised Joint Pain Advice (JPA), an intervention that can be delivered in a variety of health and community settings by a range of healthcare and non‐healthcare professionals. Here we extend JPA delivery into workplace settings.MethodIn each workplace, an advisor was trained to deliver JPA. This involved an initial assessment of participant's pain, musculoskeletal health and function (MSK‐HQ), number of days/week active for >30 min, and physical function. Participants were taught simple self‐management strategies, encouraged to adopt healthier lifestyles using motivational interviewing, goal‐settings and personalised action/coping plans. Participants were reviewed three times over 6 months, baseline outcomes reassessed, progress highlighted, health messages reinforced and action plans revised, if necessary.ResultsTwenty large public organisations or small/medium enterprises delivered JPA to 481 people. Satisfaction with the service was high; people found it acceptable, valued advice tailored to their individual needs and experienced tangible benefits—MSK‐HQ (9.5 points; CI 8.3 to 10.6), pain (−1.7; −2.2 to −1.7), physical function (−2.0; −2.2 to −1.7), activity levels and self‐confidence improved, whilst absenteeism and healthcare utilisation reduced.ConclusionDelivering advice about self‐management for chronic knee, hip and back pain in workplace settings using local health promotion or occupational health professionals and is practicable, beneficial and valued. JPA could benefit small, medium and large employers.

Determining chronic pain data elements as a first step towards improving quality of care and research in chronic pain.

Background:Chronic pain is a significant clinical problem in the world. There is still no quite effective treatment for this pain due to its complex nature. Timely retrieval of accurate and comprehensive information through organized clinical and epidemiological studies is an essential prerequisite for providing high quality clinical care and more accurate health planning. We aimed to determine minimum set of data needed as a first step in design and development of a chronic pain registry system.Materials and Methods:This descriptive-applied study was carried out in three phases; identifying necessary minimum data, preparing a primary minimum dataset, and surveying expertsby questionnaire.Result:The literature review revealed that, theprimary minimum dataset consisted of 51 elements, which were reduced to 41 after applying the experts’ opinion. This dataset covered six areas:demographic information(8 elements), initial pain assessment(12 elements), medical history (8 elements), mental health and well-being(6 elements), diagnostic measures(3elements), and diagnosis and treatment plan (4 elements).Conclusion:Determining minimum set of chronic pain data will be an effective step towards integrating and improving information management of patients with chronic pain. It will also allow for proper storage and retrieval of information related to these patients.

Assessment of the effectiveness of pain management among trauma patients in the emergency department

Background: In the emergency department (ED), pain is the most common complaint, especially among trauma patients. However, two-thirds of trauma patients are discharged from EDs with moderate to severe pain. Therefore, pain management is an important part of care in trauma patients. Objective: To assess the effectiveness of pain management among trauma patients in the ED. Method: This is a retrospective cohort study conducted on adult trauma patients who attended the ED in King Abdulaziz medical city (KAMC) in Jeddah from June 2016 to July 2018. The study evaluated if the pain was evaluated during the patient encounters, and the pain score was registered. Furthermore, we assessed if pain medications were administered, their type and dosage, and the pain score evaluation before and after administration. Pain score was scored using the numeric pain scale. Data were collected from the health information system (Best care�) and analyzed using SPSS version 24. Results: Initial pain assessment occurred only in 69% of our population, while assessment after medication administration happened in 71% of patients. The median between the time of arrival and the time of Initial Assessment was 19 minutes. The Mean difference between pain scores before and after pain management was one on a numeric pain scale with a P-Value of 0.001. 36.7% of Patients received appropriate medication based on their pain score improvement result. Opioid was used as an initial pain management drug in 35% of patients. Conclusion: There is a big room for improvement in pain management in trauma patients in emergency departments. Emergency care providers should observe the timeliness and appropriateness of pain management. Evaluation and re-evaluation of pain before and after pain medications or other pain-relieving intervention needs to be more frequent and efficient.

Initial Assessment and Monitoring of Nutritional Status and Malignant Pain in Lung Cancer Patients

Introduction. Lung cancer is a complex disease and requires a multidisciplinary approach to achieve the best results in treatment, to increase the survival rate while preserving the quality of life of the sufferer. The nutritional status of the patient is an important factor affecting outcome and recovery from disease or injury. We question whether there is a link between nutritional status and malignant pain in lung cancer patients. Aim. A prospective trial was conducted to determine the distribution of respondents by frequency of pain according to a validated Visual Analog Scale (VAS), distribution of respondents who reported reduced food intake and distribution of factors that have led to the reduced food intake. Methods. A prospective trial was conducted at the Department for respiratory diseases Jordanovac, University Hospital Center Zagreb, Croatia, on a sample of patients with advanced non-small cell lung cancer to determine the frequency, characteristics and treatment of chronic malignant pain (N=76). These are the results from November 2013 to June 2014. For pain assessment, we used a validated VAS. For the identification of patients at risk of malnutrition we used Nutritional risk screening tool (NRS 2002). For a rough estimate of total body adiposity, we measured dermal thicknesses using a standard calliper. Monitoring of patients was documented in the form of nursing documentation. A component of nursing documentation was designed to monitor the nutritional status of cancer patients and has been implemented at the Department for respiratory diseases Jordanovac as required documentation. The component included collecting the following data: the stage and type of cancer and treatment, demographic characteristics, age, gender, vital signs, body weight and height, body mass index (BMI), subjective symptoms such as pain, fatigue and nausea, reduction ad rezones of food consumption. Results. During the study 417 measurements were made: 1) 32,1% of patients reported reduced food intake, and 67,9% of respondents indicated that have not reduced their regular diet; 2) as a reason for the reduced food intake 37,7% respondents stated loss of appetite, 31,2% fatigue and 24,6% pain; 3) 59,5% subjects mainly reported absence of pain, while none of the respondents reported the existence of the highest degree of pain. Conclusion. By regular monitoring of the intensity of the pain we achieved good control in malignant pain management, which is an important data in the assessment of nutritional status. The fact is that poorly controlled pain is present in 24% of patients and has been the reason for the reduced food intake.