Non-pharmacological Management Research Articles

GAMBARAN POLA MAKAN PADA PASIEN HIPERTENSI DI RUMAH SAKIT SANTA ELISABETH MEDAN TAHUN 2023

Diet is one of the efforts in overcoming hypertension sufferers so they can control their habits by adjusting the amount of food, type of food, meal schedule and balance nutritional intake. A balanced menu needs to be started and well known so that controllable eating habits will be formed. Hypertension is a non-communicable disease that can cause blood pressure to increase where systolic and diastolic are above normal limits. Factors that can cause hypertension are genetic factors (heredity), gender, age. The aim of the study is to find out the eating patterns of hypertensive patients. The research uses a quantitative method where data collection is carried out using a questionnaire of 25 questions so as to be able to dig deeper into the diet of hypertensive patients. The sampling technique uses random sampling of 53 respondents. The data analysis technique uses is descriptive. The results of the study are: eating patterns of hypertensive patients based on the amount of food in good category 45 respondents (84.9%). The eating pattern of hypertensive patients based on the type of food is in good category, 43 respondents (81.1%). The eating pattern of hypertensive patients based on the frequency of eating was in good category, 44 respondents (83.0%). Researcher's suggestion: It can be used as a recommendation for one of the non-pharmacological management of hypertensive patients by providing health education about diet, and used as information to maintain eating patterns in hypertensive patients.

PERBEDAAN PENURUNAN KADAR GULA DARAH PADA PENDERITA DIABETES MELLITUS TIPE II DENGAN PEMBERIAN RELAKSASI OTOT PROGRESIF DAN SENAM KAKI DIABETES

Diabetes mellitus a serious chronic disease, which the pancreas is unable to produce insulin in the body, but it can also occur if the body is not effective in using the insulin produces. One of the non-pharmacological management of diabetes mellitus is progressive muscle relaxation and diabetic foot exercise. purpose of the Research: Analyze the difference in the effect of progressive muscle relaxation and foot exercises on reducing blood sugar patients with type II diabetes mellitus.Research methodology: The study used the Quasi Experimental Design method with a Static Group Comparison Design. The sample of this study was type II diabetes mellitus in the Sidoharjo Health Center, Sragen, as many as 56 respondents. Sampling using purposive sampling technique. Results: The results of the Independent Sample T-Test on progressive muscle relaxation and diabetic foot exercises showed Sig. (2-tailed) p = 0.777 where p value > 0.05. Discussin, Progressive muscle relaxation and diabetic foot exercises can be a complementary therapy to diet and pharmacology to help lower blood sugar levels. Conclusions: There is no significant difference between progressive muscle relaxation therapy and diabetic foot exercises in reducing blood sugar levels in type II diabetes mellitus patients

Nonpharmacological pain management methods used by post-operative patients: A cross-sectional study

Nonpharmacological pain management methods used by post-operative patients: A cross-sectional study

DISPARITIES AND TRENDS IN COMPREHENSIVE PAIN MANAGEMENT AMONG THE ADULT POPULATION IN THE POST-OPIOID EPIDEMIC

Abstract Introduction Chronic pain is an epidemic, but there are various therapies that are effective at treating it. Disparities in access to chronic back pain management are well documented. However, studies have largely focused on the gap in utilization between Black and White patients, and on the use opioid therapies. The extent of disparities in utilization for other groups and how disparities by demographics interact with socioeconomic characteristics, are unclear. Methods Using insurance claims from Optum Data, we identified patients who had chronic low back pain between 2010- 2020. We measured trends in pharmacological and nonpharmacological therapies, disaggregating measures by sex, age, race/ethnicity, educational attainment, income, and parenthood. We estimated linear probability models to understand which demographic and socioeconomic characteristics were most predictive of utilization. Results There were large differences in the utilization of pharmacological and nonpharmacological pain care, with surprising findings. First, we found that Black patients were the most likely to be prescribed opioids, as well gabapentin, muscle relaxers, and NSAIDs, followed by White patients, Hispanics; Asians were the least likely to engage in pharmacological therapy. Linear probability models indicated that the largest predictor of pharmacological and nonpharmacological pain management was education and income. Discussion We document disparities in pain management, which point to important policy implications. Preferences of pain management warrant further attention, as our findings suggest that income and education are the largest driver. It could be that the time and out-of-pocket costs associated with nonpharmacological pain management reduce the likelihood that patients opt for these therapies.

The results of pulpectomy in primary molars in children with negative behaviour

Relevance. A pulpectomy is a procedure predominantly performed for pulpitis treatment in single-rooted primary teeth. Data on the pulpectomy in primary molars are limited. Pulpectomy in children with negative behaviour is particularly difficult. The study aimed to determine the survival rate of primary molars after treatment of chronic pulpitis by pulpectomy in children with negative behaviour depending on the behaviour management method.Material and methods. A prospective clinical study in parallel groups involved 120 children aged 3-6 years who demonstrated negative behaviour (according to the Frankl scale) during a dental examination. Chronic fibrous pulpitis was treated by vital pulpectomy in 180 primary molars. In group 1 (60 children, 90 teeth), children underwent non-pharmacological behaviour management; in group 2, children were treated under conscious sedation (pharmacological correction of behaviour). Follow-ups after 6, 12, 18 and 24 months determined the tooth survival rate after pulpectomy.Results. The 24-month tooth survival rate after pulpectomy was 76.7% in group 1 (95% CI 67.9-85.4%), 81.1% – in group 2 (95% CI 73.0-89.2%), p > 0.05.Conclusion. More than 75% of primary molars survived for 24 months after vital pulpectomy in children with negative behaviour. The results of pulpectomy with pharmacological behaviour correction were better than after non-pharmacological behaviour management; however, the detected differences were not statistically significant.

RURAL OLDER ADULTS’ VIEWS OF DEPRESCRIBING AND NONPHARMACOLOGICAL METHODS IN PAIN TREATMENT

Abstract Proper pain management is essential to quality of life. Due to the risks of harmful drug interactions, there has been an increasing effort to reduce medication that may be harmful or ineffective (i.e., deprescribing) and to promote non-medication based (i.e., non-pharmacological) strategies in pain management. The purpose of this qualitative study is to understand the views of deprescribing and non-pharmacological methods in pain management among community-dwelling older adults with multiple chronic health conditions. Eligibility criteria included: 65+, Alabama resident living outside of nursing homes, cognitively intact, have two or more chronic health conditions and chronic pain, and take medications for their health conditions including pain medications. Participants were recruited through the Area Agency on Aging across the state of Alabama as well as other community venues serving older adults. Individual, open-ended interviews were conducted by phone to explore their concerns about medications, their views of deprescribing and using non-pharmacological pain management as well as their needs in doing so. Thematic analysis of the interview data revealed various barriers and needs: concerns about various side effects while also worrying about missing out benefits from the medications if reduced or stopped, uncertainty or skepticism toward non-pharmacological pain treatment, lacking financial and logistical access to non-pharmacological options, and lack of knowledge about available non-pharmacological options and their benefits. These findings have implications for future education and advocacy efforts to promote older adults’ knowledge and self-efficacy so that they can consider deprescribing and non-pharmacological methods in managing their pain.

Central neuropathic pain.

Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.

PAIN MEDICATION AND FALL RISKS AMONG COMMUNITY-DWELLING OLDER ADULTS WITH ARTHRITIS

Abstract Pain medication is commonly used among older adults with arthritis. Research indicates an elevated fall risk among older adults with arthritis, yet this association among those who take medication for pain is not fully studied. This population-based study investigated the association of falls with pain medication use by arthritis status. A sample of community-dwelling Medicare beneficiaries in the 2015 National Health and Aging Trends Study, representing older adults who reported arthritis (n = 4,229) and no arthritis (n = 3,258), were analyzed using survey-weighted logistic regression analysis. Sensitivity analysis was performed to investigate differences in associations by the frequency of taking pain medication. All analyses were controlled for sociodemographic characteristics, living arrangements, balance problems, and chronic conditions. The majority of participants was 70 years or older (70.7%), female (55.3%), White (80.1%), had a high school or higher education (58.4%) and had two or more chronic conditions (53.6%). Significantly higher proportions of those with arthritis reported pain (67.9% vs. 32.1%) and pain medication use (63.1% vs. 36.9%) than those with no arthritis. Pain medication use (OR = 1.11, 95% CI: 1.03, 1.20) and balance problems (OR = 4.39, 95% CI 3.45, 5.59) were associated with falls among those with arthritis. Taking medication for pain every day a week (OR = 1.48, 95% CI: 1.05, 2.09) was associated with falls among those with arthritis. Findings suggest that the heavy use of pain medication may increase fall risk. Nonpharmacological pain management education is encouraged for supporting active living among older adults with arthritis.

OPIOID PRESCRIBING AND OPIOID USE IN OLDER ADULTS: BUILDING AND REFINING A CHANGE PACKAGE FOR PRIMARY CARE

Abstract Opioid use is associated with increased risk of harms in older adults (≥65) due to physiologic changes, drug interactions, and comorbidities. The AHRQ Opioids in Older Adults project developed a change package based on an evidence review and expert recommendations that included nine high-leverage changes (HLCs) and related key activities to address safe opioid use in this population. We used the change package to support fourteen primary care practices participating in two fifteen-month learning collaboratives convened to implement innovations in safer opioid use in older adults. Given the nascent understanding of how practices address opioid safety among older adults, this presentation will describe the HLCs implemented by practices compared to the original change package offered to them as a way to validate and improve the change package for broad use and uptake. Of the original nine HLCs, practices implemented seven, including staff education, risk assessment, opioid use disorder assessment and treatment, processes and workflows, non-pharmacologic pain management, medication management, and using data to inform practice. All activities fit into an original HLC, however the activities that practices implemented varied from the original key activities identified by the literature review and expert panel. For example, under the using data to inform practice HLC, most practices struggled to complete chart reviews, and were unable to “review data regularly” as offered in the original change package. This presentation will describe strategies used to improve opioid safety for older adults in primary care.

Cough: An Introductory Guide for Speech-Language Pathologists

Purpose: The airway defense mechanism of cough is essential for human survival. Recognition is growing about the distinct role of speech-language pathologists in the nonpharmacological management of various cough disorders. This clinical focus article aims to deliver relevant education about normal and pathological cough to strengthen existing clinical knowledge and skills. Conclusions: The neuronal pathways underlying normal cough function are complex. Cough problems refer to either reduced or heightened cough stemming from various disease processes, and both clinical presentations have detrimental consequences. Current evidence supports that patients who suffer from cough dysfunction benefit from nonpharmacological interventions offered via speech therapy as an adjunct to medical treatments. Speech therapy strategies apply the higher cognitive components of cough by focusing on the deliberate modification and coordination of respiration. Future research priorities are positioned toward improving clinical outcomes for cough disorders.

Bronchiectasis with Trans Mediastinal Herniation of Left Upper Lobe in 3-Year-Old Child: A Case Report

BACKGROUND: Bronchiectasis is a disorder characterized by destruction of smooth muscle and elastic tissue due to inflammation which leads to permanent dilation of bronchi and bronchioles. It may develop in association with Cystic Fibrosis, a single severe episode or recurrent episodes of pneumonia and exposure to tuberculosis. The principal conditions associated with bronchiectasis are obstruction and infection. Infections primarily originate from issues with airway clearance, which cause bronchi and bronchioles to enlarge irreversibly. Vertical airways are notably affected, while distal bronchi and bronchioles are more severely affected. The degree of disease activity and chronicity may affect the histological findings. Childhood bronchiectasis can proceed to severe consequences including persistent bacterial bronchitis, in developing nations like India due to a lack of effective diagnosis and treatment as a result of poor health care infrastructure in the rural areas as well as limited awareness on the part of general public and health care professionals. THE CASE: A 3.5-year-old Indian boy presented with productive cough and cold for 8 days associated with low grade fever. Patient was admitted through Out Patient Department (OPD) due to respiratory distress and facial swelling. Clinical exam revealed presence of crepitation, wheeze and pectus carinatum. Patient has history of multiple hospital admissions due to pneumonia and respiratory distress. There is history of exposure to tuberculosis. His mother had been diagnosed with tuberculosis when the child was 3 months old. She received anti-tubercular drugs and is now cured. HRCT thorax reveals collapse of basal segment of right lung, trans-mediastinal space shift of left upper lobe and bi-lateral bronchiectatic changes which include unusually thickened enlarged airways exhibiting the characteristic tram-track appearance. Echocardiogram findings show thickened pericardium, mild pericardial collection and trace tricuspid valve regurgitation. The case is unique since it is quite rare for a young child to have such a severe form of bronchiectasis. CONCLUSION: Diagnosis can be done with the help of radiological and clinical examination. However, High Resolution Computed Tomography (HRCT) scan is the investigation of choice. Early management is a key factor in minimizing more serious complication like severe hemoptysis and cor pulmonale. Current treatment modalities include antibiotics, bronchodilators, anti-inflammatory drugs and chest physical therapy. Severe cases may require injectable antibiotics. Bronchiectasis was thought to be an orphan disease that seldom progressed to severe consequences, especially after the introduction of newer antimicrobials. There exist guidelines that advocate treatments for bronchiectasis, and reports of therapy have been shown to be linked with clinical success. However, such guidelines do not exist in India at present. This case is noteworthy as it portrays bronchiectasis in an Indian child that has proceeded to the severe complication of transmediastinal herniation, demonstrating that it is relatively common albeit under-diagnosed in developing countries. Though is an irreversible disease in adults, in children if detected early there is almost complete restoration of pulmonary function and adequate exercise tolerance. Early diagnosis with suitable pharmacological and non-pharmacological management is critical for a positive outcome and prevention of sequelae like persistent bacterial bronchitis.

Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study.

Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed. Prospective observational cohort pilot study. The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system. Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms. None. The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time. Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.

Mapping Evidence-Based Non-Opioid and Non-Pharmacological Pain Management Modalities Across Minnesota: The Non-Opioid Pain Alleviation Information Network Project.

Objective: The Non-Opioid Pain Alleviation Information Network (NOPAINMN) project was designed to identify, consolidate, and map evidence-based non-opioid and non-pharmacological pain management complementary and integrative health (CIH) modalities for chronic pain management across Minnesota into a searchable and informational website (www.nopainmn.org ). Methods: The Academic Consortium for Integrative Medicine & Health's Pain Task Force White Paper identifying evidence-based research of non-pharmacological pain practice (NPPC) was reviewed and referenced. National and state certifying boards and accrediting organizations for NPPC modalities were accessed to identify Minnesota-based NPPC providers' name, business/health-system affiliation, address, contact information, and credentials. The NOPAINMN website displays these data in a consumer-facing website with searchable fields such as NPPC modality type, and location with varying distances. The website was β-tested by practitioners and stakeholders for optimization. Eight main NPPC modalities and their respective subcategories were identified and mapped: Acupuncture; Integrative Medical Care (Functional medicine consultation and Integrative medicine consultation); Massage Therapy; Mind-Body Therapies (Biofeedback, Clinical Hypnosis, Mindfulness-Based Stress Reduction, and Music Therapy); Movement Therapies (Tai Chi, qigong, and Yoga Therapy); Psychology (Cognitive Behavioral Therapy); Rehabilitative Therapies (Physical and Occupational Therapy); and Spinal Manipulation. Results: All information compiled resulted in 17,155 providers/practitioners. Physical Therapy had the greatest number of reported providers (n = 5224), followed by Occupational Therapy (n = 3792), Psychology (n = 3324), Chiropractic (n = 3033), Acupuncture (n = 591), and Massage Therapy (n = 544). The Resource Map included 56 major health systems, 686 facilities, 2651 solo or private group practices, and 14 academic training schools. With web-based cross-referencing, providers and facilities were affiliated and linked with health systems to produce an interconnected mapping system. β-Testing with patients found that the website was reported as relatively easy to use and informative. Conclusion: The website was created to assist individuals, health care providers, insurance carriers, and health care facilities in finding evidence-based information and resources on NPPC to guide, support, and proactively manage and engage chronic pain patients across Minnesota.

Non-Pharmacologic management practices for Anaemia in Pregnancy: A scoping review

IntroductionAnaemia in pregnancy is a prevalent condition, impacting a significant portion of women globally and posing serious health risks to maternal and neonatal health. While pharmacological interventions aimed at reducing anaemia in pregnancy have received substantial attention, non-pharmacological approaches remain insufficiently studied. This review therefore sought to determine the available non-pharmacological management of anaemia in pregnancy and their effectiveness.MethodsFour electronic databases were searched for relevant literature and a total of 2521 records were identified. The records were reduced to 34 articles and assessed for eligibility. Thematic analysis approach was used to analyse the extracted data and a narrative summary was used to report emerging themes to answer the review question.ResultsEight records were included in the review. Effective management practices for AIP identified included nutritional interventions such as corn soya blend, red spinach, moringa, honey. Additionally, removal of fluoride from drinking water, food and other sources, and counselling-based intake of essential nutrients were found to be effective. However, one study found the consumption of only Vitamin C rich fruits to be an ineffective AIP management practice.ConclusionsNon-pharmacological managements of AIP are primarily dietary. Effective interventions included the consumption of corn soya blend, red spinach, moringa, fortified-milk groups, honey, fermented soyabeans. The study emphasizes the need further investigation into non-pharmacological AIP interventions, representing a crucial step towards improved maternal and neonatal health.

The application of behaviour modification techniques among paediatric patients in a dental set-up- A pilot study

This study was performed to evaluate the different non-pharmacological behaviour modification techniques preferred by the parents, to know whether single or multiple behaviour modification techniques are required to regulate the behaviour of the child and to assess the effectiveness of non-pharmacological behaviour modification techniques in the operating procedure. 30 children aged between 4-7 years who required pulp therapy treatment to be done under local anaesthesia were enrolled for the study with parental consent. A video containing different behaviour management techniques was shown to the parents who had accompanied the child to the operatory. A questionnaire was given to the parents for their feedback, the response to each question was coded and the values of each code were analyzed statistically. The parents’ preferred technique was applied to their children before the planned treatment. Nonpharmacological behaviour modification techniques were effective in 90% of the children and it was found to be highly significant (p ≤ 0.05). It was seen that 66.67% of the children required more than one nonpharmacological behaviour modification technique to make them behave positively. The most preferred technique by the parents in this study was Positive Reinforcement (30%).This study brings forth that nonpharmacological behaviour management techniques can be successfully used to regulate most of the children in a paediatric clinic setup.

Foot Massage Berpengaruh Terhadap Nyeri Pada Pasien Dengan Post Sectio Caesarea Di Ruang Jade RSUD Dr Slamet Garut: Studi Kasus

Section Cesarea (SC) is a method of delivering a fetus through an abdominal incision (laparotomy) and an incision in the uterus (hysterotomy). The problem that most often occurs in post-SC mothers is pain. Foot massage produces impulses that are sent through nociceptor afferent nerve fibers which make the gates close so that the pain stimulus is blocked. The aim of this study was to identify the effect of foot massage on pain in post-SC mothers in the Jade room at Dr. Slamet Hospital, Garut. The research design used is descriptive with a case study method. The research was conducted in the Jade room at Dr. Slamet Hospital, Garut. The number of participants was one client who experienced post SC for indications of placenta previa and former SC. Data was collected from the results of the assessment using the postpartum assessment format from the Department of Maternity, Faculty of Nursing, Padjadjaran University and the Numeric Rating Scale to assess pain. The results of the case study showed a decrease in the pain scale felt by the mother after SC where the pain scale before the foot massage intervention was 7/10 and after the foot massage intervention the pain scale decreased to 4/10. Thus, Foot Massage has an influence on reducing the pain scale in Post SC mothers in the Jade room at Dr. Slamet Hospital, Garut. Foot massage can be an alternative non-pharmacological management that can be carried out by nurses to reduce pain in post-SC mothers. Suggestions for future researchers are expected to use experimental research methods to reduce bias.

Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists.

Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries. A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.

Treatment of polymyalgia rheumatica: British Society for Rheumatology guideline scope.

The last British Society for Rheumatology (BSR) guideline on PMR was published in 2009. The guideline needs to be updated to provide a summary of the current evidence for pharmacological and non-pharmacological management of adults with PMR. This guideline is aimed at healthcare professionals in the UK who directly care for people with PMR, including general practitioners, rheumatologists, nurses, physiotherapists, occupational therapists, pharmacists, psychologists and other health professionals. It will also be relevant to people living with PMR and organisations that support them in the public and third sector, including charities and informal patient support groups. This guideline will be developed using the methods and processes outlined in the BSR Guidelines Protocol. Here we provide a brief summary of the scope of the guideline update in development.

Using of non-pharmacological pain methods, and the perceived barriers, among nurses in critical care unit in Palestine

BackgroundPain is alleviated in one of the two common approaches, pharmacological or non-pharmacological intervention. Using non-pharmacological methods may have beneficial effect and priority on decreasing patients’ level of pain and decreasing the side effects of pharmacological methods in ICU patients. This study aimed to assess ICU Palestinian nurses use and barriers of non-pharmacological pain management.MethodsA quantitative descriptive cross-sectional design was used to collect responses from a convenient sample of 215 nurses working in six hospitals in Plaestine. The timeframe for data collection was from August 2022 to December 2022. This study had three instrument packages. The first part is demographic data. The second is a tool that used 4-point Likert scale to examine ICU nursing use of non-pharmacological pain methods and it consisted of 16 items. The third is six items of perceived barriers to use non-pharmacological pain methods. All statistical procedures were analyzed using Statistical Package of Social Science (SPSS) version 28.ResultsMore than two-thirds of the nurses used non-pharmacological pain methods in ICU. 60% of the nurses have high levels of use, 10.2% have very high levels. The two highest perceived barriers to use nonpharmacological method were the lack of time, workload, and patient instability with 83.7% (n = 180), and 77.2% (n = 166), respectively. Demographic variables were not significantly associated with the use of non-pharmacological pain management methods, except age.ConclusionAdopting culturally sensitive non-pharmacological pain methods to decrease ICU patients’ level of pain, may positively reflected on patients’ outcome and on healthcare system. Developing, implementing and continuous monitoring of guidelines regarding using nonpharmacological for nurses and physicians are recommended which will be reflected positively on patients’ outcomes. Great efforts to overcome the barriers of lack of time and workload is impertive to increase the clinical usage of nonpharmacological pain methods.

Nine recommendations for the emergency department for patients presenting with low back pain based on management and post-discharge outcomes in an Australian, tertiary emergency department.

To ascertain and develop recommendations for analgesic management, discharge planning and further healthcare utilisation of adults presenting to an Australian tertiary ED with radicular or low back pain (LBP). This prospective cohort study included adults presenting with non-specific LBP or radicular pain to an Australian tertiary ED. Participants with trauma/cancer-related pain, and those requiring hospital admission or surgical interventions were excluded. The primary outcome was pharmacological and non-pharmacological management delivered in ED, retrospectively collected via electronic medical records. The secondary outcomes include discharge management use, and changes made due to post-discharge healthcare utilisation, as observed by weekly telephone questionnaires over 4-weeks follow-up. Of the 100 participants recruited, 94 completed follow-up. In ED, pharmacological management was received by 85%, including opioids (62%) and non-steroidal anti-inflammatory drugs (NSAIDS, 63%). Non-pharmacological management was received by 73%, including patient education (71%) and exercise prescription (37%). In the first-week post-discharge, changes to initial discharge plan occurred in 50%, mostly carried out by GPs (76%). Over the follow-up period, 51% received additional investigations/referrals. Pharmacological use decreased by 38% and non-pharmacological use decreased by 10%. 16% of opioid-naïve patients continued using opioids 4-weeks post-discharge. ED presentations for LBP were more often treated pharmacologically than non-pharmacologically, with opioids commonly prescribed and NSAIDs potentially under-utilised. Post-discharge, additional investigations/referrals, discharge analgesia reductions and maintenance of non-pharmacological management were common. Opioid initiation as a result of LBP presentations, signifies a potential 'gateway' towards unintentional long-term use. Key study findings form our nine recommendations to inform ED LBP pain management.