Non-pharmacological Pain Management Research Articles

Electric massage chairs reduce labor pain in nulliparous patients: a randomized crossover trial

BACKGROUND: Labor pain varies significantly among pregnant women, ranging from mild to extremely distressing. Non-pharmacologic pain relief methods during vaginal birth are increasingly popular, either as a complement to pharmacologic agents or at times as the primary method of pain relief. Multiple trials have reported that manual or by-hand massage reduces labor pain. The effectiveness of full-body mechanical massage using electric massage chairs on labor pain remains unexplored.OBJECTIVE: To evaluate mechanical massage using electric massage chair on labor pain in nulliparous women.STUDY DESIGN: A randomized counterbalanced crossover trial was conducted in a university hospital in Malaysia from August 2022 to February 2023. Eligible nulliparas in labor with a minimum labor pain score of 5 (0-10 numerical rating scale) were enrolled. Participants were randomized to 30 minutes on the massage chair with mechanical massage followed by 30 minutes on the massage chair without mechanical massage, or the other way around in massage sequence. The primary outcome was change in pain score comparing pain with and without mechanical massage as a paired comparison for the entire trial participants. Secondary outcomes were across arms analyses of maternal and neonatal outcomes. The paired t-test, t test, Mann- Whitney U test, Chi square test and Fisher exact test were used as appropriate for the data.RESULTS: 208 women were randomized; 104 to each intervention. Data was available from 204 participants (103 randomized to massage first and 101 to no massage first). The primary outcome of change in labor pain score (0-10 Numerical Rating Scale, NRS) after massage and no massage (all participants included after crossover, paired t-test analysis) was mean±standard deviation 4.51±2.3 vs 5.38±2.1 mean difference - 0.87 (95% CI -1.14 to -0.59), p<0.001, a significant reduction in pain score after electric chair mechanical massage compared to no massage. On the across randomized arms secondary analyses, labor pain score after their first massage chair session was 4.35±2.52 (randomized to massage first, received massage as initial intervention) vs 5.66±1.73 p<0.001 (randomized to no massage first, received no massage as initial intervention) mean difference -1.31 (95% CI -1.91 to -0.748), a significant reduction after mechanical massage. Other distal maternal outcomes (mode of delivery, labor analgesia, duration of labor and maternal agreement that mechanical massage is effective for labor pain) and neonatal outcomes (Apgar score at 1 and 5 minutes, cord artery blood pH and base excess, and neonatal admission) were not different across randomized arms.CONCLUSION: Mechanical massage using an electric massage chair significantly reduces labor pain, offering a potential non-pharmacologic pain management option during labor.

The Development and Implementation of the Fast-Pace Assessment Framework and Tiered Analgesic Orders for Opioid Optimization

BackgroundWithin the context of the opioid epidemic, changes needed to be made in the prescription and administration of analgesics. The purpose of this paper is to describe the development and implementation of a project that utilized a holistic pain assessment framework and introduced new order sets to guide the integration of nonopioid, opioid, and co-analgesics in a quaternary care medical center. MethodsAn interdisciplinary team updated policies and procedures for pain assessment and opioid administration and created new analgesic order sets for both adult and pediatric patients. Following requisite approvals, these order sets were integrated into the electronic health record. Education of clinicians, patients, and caregivers was provided to facilitate implementation of these new clinical practices. ResultsPrescribers’ levels of adherence with the use of the pain order sets ranged from 80% to 90% and no adverse effects were reported. Education of nursing staff was incorporated into hospital orientation. Ongoing evaluations are providing insights into how the new policies and procedures can be optimized to ensure reliable, safe, and effective pain management. ConclusionsSince the implementation of the opioid optimization project, adherence with the tiered, multimodal approach to analgesic prescribing is high. Next steps include both qualitative and quantitative evaluations of the benefits and challenges associated with this practice change. For example, systems will be developed to monitor nurses’ adherence with the implementation of the pain order sets and the use of both pharmacologic and nonpharmacologic pain management interventions.

Efforts to Reduce Headache in Grade II Tuberculosis Meningitis Patients: A Case Study

Tuberculous meningitis is a life-threatening disease and can cause severe manifestations and neurological disorders. Headache is one of the symptoms that occurs in patients with tuberculosis meningitis. An 18-year-old woman was admitted with complaints of unilateral headache in the holocranial region with a description of throbbing pain on a scale of 6 (0-10), which decreases when she closes her eyes and sleeps. The pain is felt continuously and slightly interferes with activities. This case study aim to describe intervention that can reduce headache in Grade II Tuburculosis Meningitis. Nursing actions are given to minimize the pain experienced by patients with tuberculosis meningitis, namely carrying out pharmacological and non-pharmacological pain management by collaborating in giving paracetamol 500 mg and teaching non-pharmacological pain management by facilitating patient rest, teaching deep breathing relaxation. In addition, immediate treatment is needed by administering anti-tuberculosis drugs (OAT) and corticosteroids. Corticosteroids are given to minimize complications and death rates by suppressing the inflammatory response in the subarachnoid space. After being given care, the problem of acute pain is partially resolved so that further treatment is needed with participation of the patient and family for the success of nursing care. It is necessary to improve pain management in treating patients with TB meningitis headaches.

Qualitative Evaluation Informs the Implementation of a Telehealth Program to Manage Chronic Pain

In response to the opioid epidemic and high rates of chronic pain among the veteran population, the U.S. Department of Veterans Affairs implemented the TelePain-Empower Veterans Program (EVP), a nonpharmacological pain management program for veterans. Delivered virtually, TelePain-EVP incorporates integrated health components (Whole Health, Acceptance and Commitment Therapy, and Mindful Movement) through interdisciplinary personalized coaching. The objective of this quality improvement project was to evaluate the implementation of TelePain-EVP to identify determinants to implementation, benefits and challenges to participation, and recommendations for future direction. We used a qualitative descriptive design to conduct semistructured telephone interviews with TelePain-EVP leaders (n = 3), staff (n = 10), and veterans (n = 22). The interview guides aligned with the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis organized and characterized findings. Several CFIR domains emerged as determinants relevant to program implementation, including innovation (eg, design); individuals (eg, deliverers, recipients); inner (eg, communications) and outer settings (eg, local conditions); and implementation process (eg, reflecting and evaluating). Identified determinants included facilitators (eg, virtual delivery) and barriers (eg, staff shortages). Participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use. Program improvement recommendations included using centralized staff to address vacancies, collecting electronic data, offering structured training, and providing course materials to veteran participants. Qualitative data can inform the sustained implementation of TelePain-EVP and other similar telehealth pain management programs. These descriptive data should be triangulated with quantitative data to objectively assess participant TelePain-EVP outcomes and associated participant characteristics. PerspectiveA qualitative evaluation of a telehealth program to manage chronic pain, guided by the CFIR framework, identified determinants of program implementation. Additionally, participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use.

The The Effect of Benson Relaxation on the Chest Pain Scale of Unstable Angina Pectoris (UAP) Patients in the HCU Ward of Bali Royal General Hospital

ABSTRACT&#x0D; Unstable angina pectoris has a typical chest pain complaint caused by a blockage of the coronary arteries which cause oxygen cannot be supplied to the myocardial cells resulting in anaerobic metabolism causing an accumulation of lactic acid which causes chest pain. One of the non-pharmacological therapies as supportive therapy can help the performance of gold standard therapy to reduce pain felt by Benson relaxation patients. The purpose of this study was to determine the effect of benson relaxation.This study used a quasy experimental design with a pre-post test design with control group design. This study involved 30 respondents, namely 15 respondents in the intervention group who were given Benson medication and relaxation and 15 respondents in the control group who were given medication only using a purposive sampling technique and measuring instruments used the Visual Analogue Scale before and after the intervention.The results showed that the pain scale in the intervention group before being given Benson relaxation was mostly moderate pain (60%), in the control group (73.3%) experienced moderate pain. The pain scale in the intervention group after being given Benson relaxation was mostly mild pain (93.3%), whereas in the control group (73.3%) experienced moderate pain. There was an effect of Benson's relaxation on the chest pain scale of Unstable Angina Pectoris patients with a p value = 0.001 &lt;0.05. It is recommended that giving Benson relaxation be used as a standard for non-pharmacological pain management for patients with unstable angina pectoris.

Cryoanalgesia for Reducing Unconscious Patients' Pain During Arterial Puncture.

Arterial puncture is a painful procedure performed to assess patients' respiratory status. Pain is a stressful situation for unconscious patients as they cannot communicate their feeling verbally. To control patients' pain and prevent the adverse effects of painkillers, nonpharmacological pain management strategies have been solicited. The aim of this study is to investigate the effect of cryoanalgesia on unconscious patients' pain during arterial puncture. We adopted a quasi-experimental one-group research design. A sample of 86 unconscious patients in a surgical intensive care unit were recruited in this study. The intervention was applying an ice pack over the puncture site for 5minutes before the arterial puncture procedure. Pain was assessed for 2 times; before and after application of cryoanalgesia. A statistically significant difference in participants' pain scores between pre-tests and post-tests was noted. For the intubated ventilated participants, the mean pain score before and after applying cryoanalgesia was 5.26 versus 4.00 (P ≤.05). For the non-intubated or intubated non-ventilated participants, the mean pain score was 6.66 versus 4.63 (P ≤.05). Cryoanalgesia is a feasible and effective method incorporate during arterial puncture along with standard procedure elements to achieve maximum pain reduction for unconscious patients during arterial punctures.

Comparison of breastfeeding, music therapy, and oral sucrose's impact on pain relief among infants during pentavalent vaccination.

Vaccination is a quick, safe, and effective way to avoid contracting hazardous diseases, but it often causes pain and discomfort. Various pharmacological and non-pharmacological pain management techniques are used to treat pain. This study aimed to compare the effectiveness of breastfeeding, musical therapy, and oral sucrose in infant's pain relief during pentavalent vaccination. A quasi-experimental posttest-only research design was used. A total of 150 infants were enrolled using the purposive sampling technique (50 in the breastfeeding, 50 in the musical therapy, and 50 in the oral sucrose groups) coming for the first, second, and third doses of pentavalent vaccination. The data were collected using observation and the Neonatal Infant Pain Scale (NIPS). The results were calculated by descriptive and inferential statistics. The study revealed that half of the infants in the breastfeeding group felt severe pain, whereas the majority of infants in the musical therapy and oral sucrose groups felt severe pain during pentavalent vaccination. The median pain score in breastfeeding, musical therapy, and oral sucrose was 4.50, 6, and 7, respectively. Breastfeeding was significantly different from both musical therapy and oral sucrose in terms of pain scores. However, no significant difference was observed between musical therapy and oral sucrose. Overall, the results indicate that breastfeeding had a distinct impact on pain relief during pentavalent vaccination compared with the other interventions, while musical therapy and oral sucrose did not differ significantly in their effectiveness. The study concluded that breastfeeding is a safe, reliable, cost-effective, and easily accessible method to relieve an infant's pain during pentavalent vaccination. It is a simple method to alleviate pain among infants during vaccination.

A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial

BackgroundGiven significant risks associated with long-term prescription opioid use, there is a need for non-pharmacological interventions for treating chronic pain. Activating patients to manage chronic pain has the potential to improve health outcomes. The ACTIVATE study was designed to evaluate the effectiveness of a 4-session patient activation intervention in primary care for patients on long-term opioid therapy.MethodsThe two-arm, pragmatic, randomized trial was conducted in two primary care clinics in an integrated health system from June 2015—August 2018. Consenting participants were randomized to the intervention (n = 189) or usual care (n = 187). Participants completed online and interviewer-administered surveys at baseline, 6- and 12- months follow-up. Prescription opioid use was extracted from the EHR. The primary outcome was patient activation assessed by the Patient Activation Measure (PAM). Secondary outcomes included mood, function, overall health, non-pharmacologic pain management strategies, and patient portal use. We conducted a repeated measure analysis and reported between-group differences at 12 months.ResultsAt 12 months, the intervention and usual care arms had similar PAM scores. However, compared to usual care at 12 months, the intervention arm demonstrated: less moderate/severe depression (odds ratio [OR] = 0.40, 95%CI 0.18–0.87); higher overall health (OR = 3.14, 95%CI 1.64–6.01); greater use of the patient portal’s health/wellness resources (OR = 2.50, 95%CI 1.42–4.40) and lab/immunization history (OR = 2.70, 95%CI 1.29–5.65); and greater use of meditation (OR = 2.72; 95%CI 1.61–4.58) and exercise/physical therapy (OR = 2.24, 95%CI 1.29–3.88). At 12 months, the intervention arm had a higher physical health measure (mean difference 1.63; 95%CI: 0.27–2.98).ConclusionThis trial evaluated the effectiveness of a primary care intervention in improving patient activation and patient-reported outcomes among adults with chronic pain on long-term opioid therapy. Despite a lack of improvement in patient activation, a brief intervention in primary care can improve outcomes such as depression, overall health, non-pharmacologic pain management, and engagement with the health system.Trial RegistrationThe study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).

Description of Perceptions of Neonatology Nurses in the Implementation of Assessment and Management of Pain in Neonates

Neonates with complications admitted to the Neonatal Intensive Care Unit (NICU) must receive various invasive actions that cause negative impacts, one of which is pain. The limited growth and development of neonates causes pain to be objective depending on the nurse's perception. As a result, pain is not managed properly and has a high risk of causing negative impacts for neonates. Objective: This study aims to identify the perception of neonatology nurses in the implementation of pain assessment and management in neonates. Method: This study used descriptive quantitative research with a cross-sectional time approach to neonatology nurses who were collected in pediatric nurse organizations in the West Java region using a convenience sampling technique. The instrument used was The Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ). Results: The results of the study with a total of 72 respondents, 50% of respondents strongly agreed on the importance of pain assessment, and 48.6% strongly agreed on the importance of using pain assessment tools. The assessment tools that are often used in assessing pain are NIPS (72.2%), and non-pharmacological pain management that is often given is physical methods. Conclusions: Although most nurses agree on the importance of pain assessment, in practice there are still nurses who assess pain without using clear assessment tools.

MANFAAT PEMBERIAN JUS NANAS DAN MADU TERHADAP PENURUNAN NYERI DESMINORE PADA REMAJA PUTRI DI SMP YP SINGOSARI DELITUA

Dysmenorrhea is abdominal pain caused by uterine contractions and occurs during menstruation. Dysmenorrhea occurs due to increased secretion of prostaglandin F2a during the luteal phase of the menstrual cycle. Increased secretion of prostaglandin F2 alpha increases the frequency of uterine contractions and as a result can cause abdominal pain in women. The effects of primary dysmenorrhea include disruption of activities, such as absence from school or work, and limitations in social life, school performance, and athletic activities. Non-pharmacological pain management includes warm compresses, drinking lots of fluids, taking regular exercise breaks, consuming nutritious food, pain relief activities such as yoga, and using herbal medicine supplements which are effective in reducing menstrual cramps. Community service was carried out at YP Singosari Delitua Middle School with a total of 20 respondents. According to the results of most students who took part in consultations at YP Singosari Deli Tua Junior High School regarding the effect of pineapple juice and honey in reducing menstrual pain in young women, the level of knowledge is still low due to lack of socialization by providing education regarding the effectiveness of pineapple juice and honey in reducing menstrual cramps. , it is hoped that students can handle this dysmenorrhoea

Knowledge of healthcare professionals about nonpharmacological pain management in the neonate in a Brazilian rooming-in: a survey study with factor analysis

Knowledge of healthcare professionals about nonpharmacological pain management in the neonate in a Brazilian rooming-in: a survey study with factor analysis

Nefarmakološke metode u terapiji bola - mehanizam dejstva (nefarmakološko lečenje bola)

Pain is a major health issue representing a leading cause of disability. It affects millions of adults worldwide and impose significant burdens on society, healthcare systems, and personal well-being. The management of chronic pain presents a major challenge for healthcare professionals, as there is no single or universally effective treatment. Conventional treatments such as opioids and nonsteroidal anti-inflammatory drugs are first line treatment, but they carry significant risks and limitations, including addiction, tolerance, dependence, adverse effects, especially when used long term. As a result, additional approaches are needed to provide effective and safe chronic pain relief. Non-pharmacological pain management strategies represent a promising domain especialy as a part of complementary tailored to individual needs and integrated to contemporary pain medicine.

Motivating Physical Activity with a Walking Exercise Behaviour Intervention and Pain Management Remotely in Intermittent Claudication (MAvERIC): protocol for a randomised controlled feasibility trial

Background: Physical activity (PA) through walking exercise improves functional capacity and quality of life and provides secondary prevention benefits in individuals with peripheral arterial disease (PAD) and intermittent claudication (IC). However, there are many barriers to uptake and maintenance of PA in this population including pain and limited motivation. The aim of this study is to test the feasibility and acceptability of delivering a clinical trial to evaluate the effect of using a walking exercise behaviour change intervention, modified to include the use of a transcutaneous electrical nerve stimulation (TENS) device for non-invasive pain management, to increase walking-based PA in individuals with PAD and IC in comparison with usual care. Methods: This is a randomised controlled analysis-blinded feasibility study with two parallel groups. We will recruit 48 adults with PAD and IC from NHS Lanarkshire vascular service. Inclusion criteria are: PAD (ankle brachial pressure index &lt;0.90) and stable IC for &gt;3 months, being able and willing to participate, and to provide informed consent. Participants will be randomly assigned 1:1 to intervention plus usual care or usual care alone. Usual care includes best medical therapy, information on PAD, walking advice or home exercise programme, and managing risk factors. The intervention consists of a home-based, walking exercise behaviour change intervention (MOSAIC), adapted for remote delivery, and includes non-pharmacological pain management through a TENS device. Feasibility and exploratory outcomes will be assessed at baseline, after 6 and 12 weeks of intervention, and at 6 and 12 months follow-up. The primary outcomes are trial process and intervention feasibility, as well as intervention acceptability measured using rates of participant recruitment and retention, intervention adherence, and the Theoretical framework of Acceptability questionnaire. Exploratory outcomes include daily PA and patient-reported outcomes including quality of life, pain self-efficacy and catastrophising, and walking impairment pain intensity and quality. Conclusion: This trial will evaluate the feasibility and acceptability of a remotely delivered walking exercise behaviour change intervention adapted to include the use of a TENS device to improve PA in individuals with PAD and IC. Trial Registration Number: ClinicalTrials.gov Identifier: NCT06114732

Engagement in Integrative and Nonpharmacologic Pain Management Modalities Among Adults with Chronic Pain: Analysis of the 2019 National Health Interview Survey.

To examine variables associated with engagement in (1) integrative health and medicine (IHM) and (2) nonpharmacologic modalities rather than opioids among United States adults with chronic pain. Using the 2019 National Health Interview Survey, we examined sociodemographic, pain, and mental health predictors of (1) the sum of IHM modalities (ie, chiropractic care, yoga/Tai Chi, massage, or meditation/guided imagery) used to manage pain and (2) exclusive engagement in nonpharmacologic pain management modalities (ie, IHM, a chronic pain self-management program, support groups, or physical, rehabilitative, occupational, or talk therapy) or opioids in the past 3 months. Metropolitan residency, higher family income, higher education levels, increased number of pain locations, and increased frequency of pain limiting life/work activities were associated with increased odds of IHM engagement. Older age, male sex, non-Hispanic Black/African American race/ethnicity, and daily opioid use were associated with decreased odds of IHM engagement. Older age, male sex, and increased depressive symptoms were associated with decreases in the count of IHM modalities used to manage pain. Metropolitan residency, higher family income, and higher education levels were associated with increased odds of exclusive nonpharmacologic modality engagement. Older age and increasing frequency of pain limiting life/work activities were associated with decreased odds of exclusive nonpharmacologic modality engagement. We identified several contrasts between factors prevalent among individuals with chronic pain and factors associated with engagement in nonpharmacologic and IHM modalities. These results support efforts to address barriers to accessing these modalities among subpopulations of adults with chronic pain (eg, older adults, individuals identifying as Black/African American, rural residents, and those with lower levels of education and income).

Navigating Pain in Rheumatology: A Physiotherapy-Centric Review on Non-pharmacological Pain Management Strategies.

Rheumatism is a broad term for the painful afflictions of the musculoskeletal system, which include a variety of symptoms ranging from vague pain or aching to profound disability. This article explores the imperative role of physiotherapy in navigating pain within the field of rheumatology, providing a comprehensive review of non-pharmacological pain management strategies. A literature search of PubMed, Web of Science, Scopus, and Cochrane databases was conducted, employing keywords like "Pain," "Rheumatic disease," and "Physiotherapy," with the review emphasizing recent English studies, particularly randomized trials, meta-analyses, and systematic reviews over the last 10 years, to consolidate evidence on the efficacy of physiotherapy interventions for individuals with rheumatic disease. Pain, a significant challenge for individuals with rheumatic diseases, is often intense and persistent, associated with subsequent physical disability, but employing a holistic approach encompassing drugs, physical therapy, and patient education can yield substantial benefits in managing these painful conditions. In addition to pharmacological interventions, management strategies incorporate a non-pharmacological approach, encompassing rehabilitation and physical therapy in alignment with the International Classification of Functioning, Disability, and Health (ICF) model. The patient and physiotherapist collaborate to develop a goal-oriented treatment plan, utilizing modalities like heat, cold, electrotherapy, and hydrotherapy for pain management, progressing to mobility enhancement, posture re-education, and activities focused on a range of motion and muscle strengthening.

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.

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.

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.

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.